Cervical cancer screening Flashcards
When do Pap smears begin
Age 21
What is the recommended screening for cervical cancer
Begin at age 21
Every 3 years until age 30
30-65yo:
Every 5 years with HPV testing
OR
Pap smear alone every 3 years
OR
High risk HPV testing alone every 5 years (may start at age 25)
Stop at age 65 if no history of CIN 2/3 or AIS and appropriate screening done
Do you need a pap after hysterectomy
For benign indications: stop
If hx of CIN 2/3 or AIS: continue pap alone every 3 years until 25 years after initial post treatment surveillance
If hysterectomy done for treatment of CIN 2/3 do annual cytology x3, then q 3 years until 25 years after tx
When is excisional > ablative
For HSIL (CIN2 or CIN3) or AIS
How do you manage atypical glandular cells and AIS cytology in non pregnant pts
Colposcopy and ECC
Endometrial sampling
- >35yo
- <35 you with risk factors for EIN
How do you manage a colposcopy result for AGC/AIS
AIS or AGC, favor neoplasia–> cone + ECC
CIN2/3–> general guidelines
<CIN2, no AIS –> cotesting annually for 3 years
How do you manage endometrial cells on cytology
Benign endometrial cells
– Premenopausal–> no eval
– Postmeno–> EMB
Atypical endometrial cells
– ECC, EMB; if negative add colposcopy
Cervical cancer screening in pregnancy
No ECC
Excisional bx or repeat bx only indicated to r/o invasive cancer
Histologic CIN 2/3: colpo q 12-24 weeks preferred
Can defer colpo until pp (acceptable)
Cervical cancer screening in HIV pts
Screen annually
- begin at diagnosis but no sooner than 21
- <30yo screen with cytology annually x3 normal then q3 years
- >30yo screen with cotesting, then q3 years if normal
- Screen for LIFE
When is an ECC indicated
Recommended:
- High grade cytology
- HPV 16/18
- SCJ not visualized
- Previously treated for known or suspected cervical dysplasia
- Considering obs of CIN2
- Positive on dual staining for P16/Ki67
Preferred:
>40
Acceptable:
All non pregnant pts undergoing colposcopy
What is the management for positive margins on LEEP for CIN2-3
Follow up with HPV testing
- HPV in 6 months
- If negative, then HPV annually x3 years, if all negative then every 3 years for 25 years
- If positive, colpo/bx
Colpo with ECC in 6 months is acceptable
Re-excision acceptable if >25 and future obstetric risk not a concern
Treatment of CIN2/3
Need to do an excisional procedure before hysterectomy to rule out any cancer.
Can do hyster if recurrent CIN 2/3, cervix too small to re biopsy
BUT Re-coning is preferred
what is the management of AIS
Associated with skip lesions therefore hysterectomy is the treatment of choice in women who complete child-bearing
Excisional bx is required to confirm dx before making subsequent management decisions
