cervical cancers, dysplasia, screening, Mgmt

Question 1

sensitivity of pap smear is only 60-80% BUT pap smears reduce the incidence of invasive cervical carcinoma by __%

Answer 1

95%

Question 2

which area is very susceptible to HPV?

Answer 2

transformation zone of cervix: area of metaplasia where squamous cells (ectocervix) and columnar cells (endocervix) meet.

Question 3

what information does the bethesda classification give you?

Answer 3

cytology: tells you what the cells from a pap smear LOOK like, NOT what the tissue is (doesn’t Dx the cancer)

Question 4

are more pap specimens liquid-based or slide-smear?why?

Answer 4

liquid-based, these are good for doing HPV testing, GC and chlamydia

Question 5

ACOG- no cervical cancer screening of girls under age ___ . why?

Answer 5

21

abnormal pap results are VERY common before this age.

Question 6

ACOG reccomends cervical cancer screening for women age __ - ___ at an interval of every __yrs.

Answer 6

21-65yo every 3 years (if they have never had an abnormal result)

Question 7

when can you stop screening women for cervical cancer?

Answer 7

age 65 only if they have a history of ALL normal results (clear for 20 years)

Question 8

before age 21, there is a __% chance that ___ _____ and ___ can be cleared by itself in a __ year period.

Answer 8

90%, HPV infection and dysplasia can be cleared by itself in a 3 year period.

Question 9

women who have had a high-grade abnormal pap result must get screening how often? how long does this interval continue?

Answer 9

they need ANNUAL SCREENING for 20years EVEN if they’ve had a hysterectomy with cervix removed

Question 10

_____ _____ has a high spontaneous clearance rate

Answer 10

cervical dysplasia

Question 11

most important cause of cervical dysplasia and cancer?

Answer 11

HPV

Question 12

HPV strains ___ and ___ are responsible for __% of cervical cancer in the US

Answer 12

16, 18, 70%

Question 13

what is the bethesda classification system?

Answer 13

from American society of colposcopy and cervical pathology: a way of describing pap smears so txt guidlines can be unified worldwide
(groups: ASC-US, ASC-H, LGSIL/LSIL, HGSIL/HSIL, AGC, AGC-US)

Question 14

pap shows ___ cells (what classification is this?)

what do you need for Dx?

Answer 14

dysplastic cells. (cytology is bethesda classification)

For Dx you need TISSUE through biopsy (histology = CIN stages)

Question 15

what are the two most concerning groups of the bethesda classification system?

Answer 15

HGSIL/HSIL : high grade squamous intraepithelial lesion

AGC or AGC-US: atypical glandular cells (of undetermined significance)

Question 16

what is the most common abnormal pap result? what causes this?

Answer 16

ASC-US: atypical squamous cells of undetermined significance (usually from inflammatory response from infection or atrophy)

Question 17

there is only a ___% infection risk by high risk- HPV from ASC-US. when is HPV typing useful? (high risk positive vs high risk negative?)

Answer 17

65%

positive: colposcopy
negative: repeat pap in 3 years

Question 18

what if pap result is ASC-H, what do you need to do? why ?

Answer 18

“atypical squamous cell - can’t rule out high grade” .. higher rate of HPV infection so you need colposcopy

Question 19

what is LGSIL? what does management of this depend on?

Answer 19

low grade squamous intraepithelial lesion . depends on age and HPV
(status negative HPV test …and under 24- repeat test with only cytology.. and over 24- repeat test with co-test)

Question 20

what is colposcopy?

Answer 20

magnified view of the cervix : soak cervix in vinegar (acetic acid) or iodine (lugol’s solution) and observe cellular changes with bare eye or colposcope.
** Can be dont with minimal equipment

Question 21

what is “co-testing”?

Answer 21

HPV and pap smear together (cytology AND histology)

Question 22

what is HGSIL? what do you do if you get these results?

Answer 22

high-grade squamous intraepithelial lesion

colposcopy REGARDLESS of age

Question 23

what do you need if you get any AGC result?

Answer 23

colposcopy AND

biopsy (endocervical curettage) AND endometrial biopsy

Question 24

why do you need endometrial biopsy if you have AGC results?

Answer 24

differentiate between endometrial and endocervical cells

THIS is a high level of concern

Question 25

Age 21-24: with Hx of normal pap results, how often do you do routine screening? (maybe weeds)

Answer 25

pap every 3 years

Question 26

Age 25-29: with Hx of normal pap results, how often do you do routine screening?(maybe weeds)

Answer 26

pap every 3 years

Question 27

Age 30+ (HPV negative): how often do you do routine screening?(maybe weeds)

Answer 27

pap every 3 years BUT prefer co-test every 5 years

Question 28

Age 30+ (HPV positive): how often do you do routine screening?(maybe weeds)

Answer 28

HPV typing BUT prefer co-test ever year

Question 29

ASC-US age 21-24(maybe weeds)

Answer 29

reflex HPV test, BUT prefer repeat pap in 1 year

Question 30

ASC-US age 24-29(maybe weeds)

Answer 30

repeat pap in 1 year, BUT prefer reflex HPV test

Question 31

ASC-US age 30+ HPV negative(maybe weeds)

Answer 31

repeat co-testing in 3 years

Question 32

ASC-US age 30+ HPV positive(maybe weeds)

Answer 32

colposcopy

Question 33

LSIL age 21-24 (maybe weeds)

Answer 33

repeat pap in 1 year

Question 34

LSIL age 24-29(maybe weeds)

Answer 34

colposcopy

Question 35

LSIL age 30+ HPV negative (maybe weeds)

Answer 35

colposcopy BUT prefer repeat pap in 1 year

Question 36

LSIL age 30+ HPV positive (maybe weeds)

Answer 36

colposcopy

Question 37

anyone with ASC-H?

Answer 37

colposcopy!

Question 38

HSIL age on anyone over 24? (maybe weeds)

Answer 38

colposcopy (or excision txt)

Question 39

AGC on any age? what is the follow-up treatment?

Answer 39

vary depending on AGC subcategory but include colposcopy, endocervical and endometrial sampling

Question 40

what is CIN?

Answer 40

cervical intraepithelial neoplasia AKA cervical dysplasia. A histological Dx. (CIN 1-3) higher CIN number = worse

Question 41

HIV infection or immunosuppressed pts, proceed to ____ for any pap abnormality!

Answer 41

colposcopy!

Question 42

DES exposure pts, what was this known to cause? what is there an increased risk of ?

Answer 42

causes abnormalities of uterus and cervix in women who were exposed in utero. higher risk of vaginal cancer

Question 43

DES exposure pts need screening how often?

Answer 43

yearly!

Question 44

who is HPV infection most common in ?

Answer 44

teens and early 20s

Question 45

vaccines are against what HPV strains?

Answer 45

16 and 18

Question 46

screening rules for women under 20years old (weeds)

Answer 46

Considered anyone 20 and younger Very likely to regress spontaneously – Pap should not be done However, IF Pap is done … If result is ASCUS, ASC-H or LGSIL, repeat Pap in 1 year If Pap still LGSIL or less in a year, repeat Pap in 12 months Colposcopy for HGSIL

Question 47

screening for post-menopausal women (weeds)

Answer 47

Often have atrophic vaginal mucosa and cervical mucosa Atrophic cells can appear dysplastic Transformation zone often regressed far inside the endocervical canal Give vaginal estrogen (if no contraindication) and repeat Pap HPV typing helpful

Question 48

is HPV testing useful?

Answer 48

useful for ASCUS to determine txt plan | - more useful in older patients b/c clearance is less likely (those over 25)

Question 49

when did/does gardasil 9 come out?

Answer 49

october 2018

Question 50

what was the first gardasil?

Answer 50

quadrivalent for 6, 11, 16, 18

Question 51

CIN stages (1,2,3, CIS)

Answer 51

1: mild, 2: moderate, 3: severe CIS: carcinoma in situ

Question 52

CIN peaks in the ___s

Answer 52

20s

Question 53

____ in every ___ deaths is cancer related (of any type of cancer)

Answer 53

1 in 4

Question 54

FIGO staging of cervical cancer: staging can be based on ___ not ___ findings. why is this important?

Answer 54

clinical not surgical findings - allows staging in areas with limited resources (when surgery not available) .. however its still used in institutions where surgery IS available

Question 55

risk factors for cervical cancer (maybe weeds)

Answer 55

Early age at first intercourse Multiple partners or a partner with multiple partners Lower socioeconomic group (age at first intercourse?) Smoking Immunodeficient Oral contraceptive use

Question 56

txt for cervical cancer( maybe weeds)

Answer 56

Surgery (simple hysterectomy) only for stage IA1; total hysterectomy; or conservative surgery if fertility desired Greater than IA1 stage needs lymph node dissection and radical hysterectomy (with BSO, LND) Possible radiation + chemotherapy

Question 57

cervical cancer prevention (maybe weeds)

Answer 57

Awareness Routine Paps HPV Vaccination Condom use- prostaglandins in semen fuel dysplasia growth; prevent spread of HPV and other STIs Dietary (high vegetable consumption decreases risk of acquiring HPV by 54%)

Question 58

what is the GOLD standard in Dx cervical dysplasia and cancer?

Answer 58

colposcopy