Cervical Cancer Screening Flashcards
what is the cause of virtually all cases of cervical cancer?
HPV
how does the anatomy of the cervix change as a patient ages?
squamocolumnar junction moves closer to the external os
NILM
negative for intraepithelial lesions or malignancy
ASCUS
atypical squamous cells of undetermined significance
LSIL
low-grade squamous intraepithelial lesion
ASC-H
atypical squamous cells, cannot exclude HSIL (high grade)
HSIL
high-grade squamous intraepithelial lesion
AGC
atypical glandular cells
lesion in which part of the epithelium is replaced by cells showing varying degrees of atypia
dysplasia
low-grade lesion with low risk of progression; mild atypia in lower third of epithelium
CIN 1
moderately atypical cells confined to the lower 2/3 of epithelium
CIN 2
strong predictor for progression to cervical cancer; severely atypical changes where over 2/3 of the epithelial thickness and includes full-thickness lesions
CIN 3
at what age should cervical cancer screening begin?
21
what is used to screen for HPV?
cytology (pap smear) q 3 years
what patients need testing for STIs?
< 25 and sexually active
what is not considered a risk factor for cervical cancer?
family history
what HPV type has the highest carcinogenic potential (#1 cause) and associated with squamous cell carcinoma?
HPV-16
what HPV type has the 2nd highest carcinogenic potential (#2 cause) and associated with adenocarcinoma?
HPV-18
what are 3 known factors that increase the likelihood of persistent HPV?
smoking
immunocompromised state
HIV
what age does HPV vaccination start and up to what age?
as early as 9
up to 45 yo
at what age, regardless of sexual status or partner gender, does pap smear begin?
age 21
31 year old comes to clinic for an annual exam. She thinks her last pap was 2-3 years ago and she thinks she had an abnormal pap 10 years ago that resolved without treatment. how often should cervical cancer screening be done? what tests should you order?
every year
cytology (pap smear)
co-testing
for patients aged 21-30, how often should cytology (pap smear) be done?
every 3 years
for patients aged 30 and older, how often should cytology (pap smear) and HPV be done?
every 5 years
at what age can pap smear be stopped if patient has not had any abnormal findings?
65
how often should patients with HIV and immunocompromised patients receive a pap smear?
annually for 3 yrs, then q 3 years for life if normal
how often should patients with exposure to DES in utero receive a pap smear?
annually
how often should a patient with a history of CIN2 receive a pap smear/HIV test?
every year x 3 years, then q3 years x 25 years
if patient does not have a _____, you should not perform a pap smear
cervix
a 28 yo patient has a pap that returns as ASC-US (atypical squamous cells of undetermined significance). Has never had an abnormal pap. what is the next step?
colposcopy (biopsy)
a 28 yo patient has a pap that returns as ASC-US (atypical squamous cells of undetermined significance). Has never had an abnormal pap. After getting a colposcopy, it reveals a CIN3 on several biopsies. what is our management?
diagnostic excisional procedure
a 40 yo presents for her well-woman visit and during the pelvic exam, you see the following:
what should we do?
biopsy
