Cervical Cancer Screening Flashcards
What percentage of cervical cncer occurs in women who don’t get paps?
50%
WHat percentage of cervical cancer occurs in women who had a false negative pap
30%
When does cervical cancer risk peak?
late 30s
and then a second peak in the late 60s
What is asc-us
atypical squamous cells of udnetermined significance
What is LSIL
low grade squamous intra-epithelial neolasi
what is HSIL
high grade squmous intrapeitlieal neoplasi
WHat is ASC_H
atypical squamous cells of undetermiend significance can’t exclude high grade
What is AGS-NOS
atrypical glandular cells - NOS
what is AGS
atypical glandular cells - favor neoplasi
What is AIS
adenocarcinoma in situ
What are the grades in histology?
CIN 1, 2, 3 cervical intra-epithelial neoplasia
CIS - carcinoma in situ
AIS - adenocardinoma in situ
What makes CIN 1? 2? 3? CIS?
1 - lower third
2 - into middle third
3 - into upper third, but not all the way up
CIS - all the way up to the top (haven’t invaded basement membrnae)
What do you look for in a colposcopy?
you zoom in, spray vinegar on it, and look for acetowhite changes (thicker abnormal skin will pick up the vinegar)
then biopsy
What’s between CIS and invasive cancer?
microinvasion - when you get a few cells under the GBM - measured in milimeters of depth (it’s a minute change)
How is cervical cancer staged beyond microinvasion?
clinically - no matter what they find on biopsy or surgery, the staging stays the same.
True or false: invasive cancer can be missed by a pap
true - but the clinical should see it
What are the major oncogenic types of HPV?
16 and 18
followed by 31 and 33
WHat are the cervical cancer high risk factors?
HIV
immunosuppressed
history of abnormal paps in prior 10 years
history of cervical cancer
history of CIN2/3/CIS
history of in utero DES exposure
partner who slept with someone else with cervical cancer
At what age do we start paps now?
age 21 (regardless of when they started having sex)
WHy was this change made if 50% of those under 21 will have it?
because 90% will resolve within 2 years
CIN is very common in those under 21 as well. Why don’t we do anything about it right away?
usually regresses spontaneously
At age 21-29, how often do you do paps?
every 3 years
Is HPV testin recommended in age 21-29?
only if they have ASC-US on pap
Age 30-65, when do you do pap?
every 3 years if alone
every 5 years if you do HPV testing with it
Age over 65?
don’t screen women who have had adequate prior screeing and are low risk
even if they have a new sexual partner
What is adequate prior screening?
3 consecutive negative cytology screenings at 3 year intervals within previous 20 years or 2 consecutive negative cotest within the previous 10 years
What do you do in HIV positive patients?
screen at 6 month intervals until 2 pap tests are negative, then annual screening
begin screening at time of diagnosis - regardless of age.
What is the screening guideline following total hysterectom?
do not screen women who have undergone removal of the cervix and have no history of CIN2+ or cervical cancer
but continue to screen if history of CIN/2/3/CIS, adenocarcinoma in-situ, or cancer
So when is HPV testing appropriate?
iwth ASC-US postmenopausal women with LGSIL primary screen if over age 30 as an adjunct to cytology follow-up after treatment for CIN2 and 3 Follow-up after CIN1 if you'r eover 21
What types does gardasile protect against?
16, 18, 6, 11
What’s the typical age to give?
ages 9-26
What does cervarix protect against?
16 and 18
What is the advantage of the gardasil?
6 and 11 cause genital warts
What is gardasil about to come out with?
gardasil 9, which will protect against 5 more high risk types
not sure about people who have already had the old version
Wahat do you do if the cytology is negative, but HPV is positive on cotesting?
just repeat co-testing in 1 year
or do immediate genotype specific testing for HPV 16/18
if 16 or 18 - do colposcopy right away
Women who have either spontaneous regression or appropriate treatment of CIN2 or higher should continue screening for how long?
at least 20 years, regardless of whether it takes them past 65 yrs
