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
why do you need endometrial biopsy if you have AGC results?
differentiate between endometrial and endocervical cells
THIS is a high level of concern
Age 21-24: with Hx of normal pap results, how often do you do routine screening? (maybe weeds)
pap every 3 years
Age 25-29: with Hx of normal pap results, how often do you do routine screening?(maybe weeds)
pap every 3 years
Age 30+ (HPV negative): how often do you do routine screening?(maybe weeds)
pap every 3 years BUT prefer co-test every 5 years
Age 30+ (HPV positive): how often do you do routine screening?(maybe weeds)
HPV typing BUT prefer co-test ever year
ASC-US age 21-24(maybe weeds)
reflex HPV test, BUT prefer repeat pap in 1 year
ASC-US age 24-29(maybe weeds)
repeat pap in 1 year, BUT prefer reflex HPV test
ASC-US age 30+ HPV negative(maybe weeds)
repeat co-testing in 3 years
ASC-US age 30+ HPV positive(maybe weeds)
colposcopy
LSIL age 21-24 (maybe weeds)
repeat pap in 1 year
LSIL age 24-29(maybe weeds)
colposcopy
LSIL age 30+ HPV negative (maybe weeds)
colposcopy BUT prefer repeat pap in 1 year
LSIL age 30+ HPV positive (maybe weeds)
colposcopy
anyone with ASC-H?
colposcopy!
HSIL age on anyone over 24? (maybe weeds)
colposcopy (or excision txt)
AGC on any age? what is the follow-up treatment?
vary depending on AGC subcategory but include colposcopy, endocervical and endometrial sampling
what is CIN?
cervical intraepithelial neoplasia AKA cervical dysplasia. A histological Dx. (CIN 1-3) higher CIN number = worse
HIV infection or immunosuppressed pts, proceed to ____ for any pap abnormality!
colposcopy!
DES exposure pts, what was this known to cause? what is there an increased risk of ?
causes abnormalities of uterus and cervix in women who were exposed in utero. higher risk of vaginal cancer
DES exposure pts need screening how often?
yearly!
who is HPV infection most common in ?
teens and early 20s
vaccines are against what HPV strains?
16 and 18
screening rules for women under 20years old (weeds)
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
screening for post-menopausal women (weeds)
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
is HPV testing useful?
useful for ASCUS to determine txt plan
- more useful in older patients b/c clearance is less likely (those over 25)
when did/does gardasil 9 come out?
october 2018
what was the first gardasil?
quadrivalent for 6, 11, 16, 18
CIN stages (1,2,3, CIS)
1: mild, 2: moderate, 3: severe
CIS: carcinoma in situ
CIN peaks in the ___s
20s
____ in every ___ deaths is cancer related (of any type of cancer)
1 in 4
FIGO staging of cervical cancer: staging can be based on ___ not ___ findings. why is this important?
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
risk factors for cervical cancer (maybe weeds)
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
txt for cervical cancer( maybe weeds)
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
cervical cancer prevention (maybe weeds)
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%)
what is the GOLD standard in Dx cervical dysplasia and cancer?
colposcopy
