cervical cancers, dysplasia, screening, Mgmt Flashcards
sensitivity of pap smear is only 60-80% BUT pap smears reduce the incidence of invasive cervical carcinoma by __%
95%
which area is very susceptible to HPV?
transformation zone of cervix: area of metaplasia where squamous cells (ectocervix) and columnar cells (endocervix) meet.
what information does the bethesda classification give you?
cytology: tells you what the cells from a pap smear LOOK like, NOT what the tissue is (doesn’t Dx the cancer)
are more pap specimens liquid-based or slide-smear?why?
liquid-based, these are good for doing HPV testing, GC and chlamydia
ACOG- no cervical cancer screening of girls under age ___ . why?
21
abnormal pap results are VERY common before this age.
ACOG reccomends cervical cancer screening for women age __ - ___ at an interval of every __yrs.
21-65yo every 3 years (if they have never had an abnormal result)
when can you stop screening women for cervical cancer?
age 65 only if they have a history of ALL normal results (clear for 20 years)
before age 21, there is a __% chance that ___ _____ and ___ can be cleared by itself in a __ year period.
90%, HPV infection and dysplasia can be cleared by itself in a 3 year period.
women who have had a high-grade abnormal pap result must get screening how often? how long does this interval continue?
they need ANNUAL SCREENING for 20years EVEN if they’ve had a hysterectomy with cervix removed
_____ _____ has a high spontaneous clearance rate
cervical dysplasia
most important cause of cervical dysplasia and cancer?
HPV
HPV strains ___ and ___ are responsible for __% of cervical cancer in the US
16, 18, 70%
what is the bethesda classification system?
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)
pap shows ___ cells (what classification is this?)
what do you need for Dx?
dysplastic cells. (cytology is bethesda classification)
For Dx you need TISSUE through biopsy (histology = CIN stages)
what are the two most concerning groups of the bethesda classification system?
HGSIL/HSIL : high grade squamous intraepithelial lesion
AGC or AGC-US: atypical glandular cells (of undetermined significance)
what is the most common abnormal pap result? what causes this?
ASC-US: atypical squamous cells of undetermined significance (usually from inflammatory response from infection or atrophy)
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?)
65%
positive: colposcopy
negative: repeat pap in 3 years
what if pap result is ASC-H, what do you need to do? why ?
“atypical squamous cell - can’t rule out high grade” .. higher rate of HPV infection so you need colposcopy
what is LGSIL? what does management of this depend on?
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)
what is colposcopy?
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
what is “co-testing”?
HPV and pap smear together (cytology AND histology)
what is HGSIL? what do you do if you get these results?
high-grade squamous intraepithelial lesion
colposcopy REGARDLESS of age
what do you need if you get any AGC result?
colposcopy AND
biopsy (endocervical curettage) AND endometrial biopsy