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Women's Health Theory > Cervical cytology > Flashcards

Cervical cytology Flashcards

1
Q

Describe the ectocervix

A

 Ectocervix, Portio, Anterior & Posterior lips, vaginal surface of cervix
 Extends from external os to vaginal fornix
 Protects underlying tissue
 Estrogen repsonsive

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2
Q

Describe the endocervix

A

Glandular columnar cells are in the endo cervix
 Single layer mucin-producing columnar cells
 Extend from internal os (proximal) to the external os
(distal) ~ liens endocervical canal going into the uterine
cavity

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3
Q

What is the squamocolumnar junction

A

is the site of active metaplasia, or conversion of one cell type (columnar) to another (squamous)

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4
Q

What affects the SCJ?

A

o Estrogen dependent  estrogen exposure pushes the glandular cells out

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5
Q

What is often the site of cellular abnormalities in the cervix?

A

Zone of transformation

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6
Q

What is ectopy?

A

pronounced eversion of the columnar epithelium

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7
Q

Who presents with ectopy?

A
  • Women that are pregnant or using hormonal contraception
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8
Q

What is considered a persistent HPV infection? What is the most persistent subtype?

A

-Over 2 years with the same HPV type
-16 is the most persistent subtype

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9
Q

HPV primary prevention? Who qualifies?

A

9-valent vaccine
M/F ages 9-45
suggested to do it age 11-12

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10
Q

Secondary prevention HPV

A

Pap

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11
Q

How many strands of HPV are oncogenic?

A

approximately 20

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12
Q

Which strands cause genital warts?
Which strands are high risk?

A
  • warts: 6 & 11
    -high risk: 16 & 18
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13
Q

What percentage of HPV clears in 1 year? 2 years?

A
  • 1 year = 70%
  • 2 years = 90%
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14
Q

S/s cervical cancer

A

-abnormal vaginal bleeding
-postcoital bleeding
-vaginal discharge –> watery, mucoid, purulent, malodorous

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15
Q

Define: colposcopy

A

magnification and illumination to aid visual inspection of the cervix, vagina, and anogenital area

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16
Q

What occurs during a colposcopy?

A

o Dilute acetic acid applied to cervix or vagina to highlight dysplastic areas
o Targeted biopsies are performed based on clinician’s assessment

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17
Q

What is a histology?

A

study of tissue

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18
Q

How is histology tissue obtained?

A

during colposcopy

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19
Q

What is squamous metaplasia?

A

 Normal process
 Triggered by exposure to acid environment of vaginal
from increased estrogen levels
 Columnar epithelium is replaced by squamous
 Common to see gland opening and Nabothian cysts
 Vulnerable to oncogenic HPV
 This area will turn white with acetic acid application
because this correlates with cells changing

20
Q

What is dysplasia?

A

abnormal tissue typically affected by HPV; cervical intraepithelial neoplasia (CIN) – looking at tissue that turned white with acetic acid because we know that abnormal cells are targeted and turn white

21
Q

What are the different classifications of dysplasia

A

 Normal
 Mild Dysplasia (CIN 1): 1/3 squamous epithelium is abnormal  < 1% progress; 10% progress to 2/3
 Moderate Dysplasia (CIN 2): 1/3- 3/4 epithelium is abnormal  ~ 5% progress to ICC
 Severe Dysplasia (CIN 3): >3/4 epithelium is abnormal
* Older term Carcinoma in situ (CIS): Full thickness lesion
* 12-40% progress to ICC  considered a direct precursor to cervical cancer
 Invasive Cervical Cancer: Abnormal cells break through the basement membrane lead to invasion of surrounding tissues

22
Q

What are atypical glandular cells

A

endocervical cells, endometrial cells or glandular cells

23
Q

What is the most common type of cervical cancer?

A

Squamous cell carcinoma

24
Q

Where does squamous cell carcinoma develop?

A

Squamous cells of ectocervix

25
Q

What develops from glandular cells?

A

adenocarcinoma

26
Q

What to avoid (patient) before pap?

A
  • Patient should avoid intercourse, douching, tampon use or vaginal meds 2 days prior
27
Q

Tools and techniques of performing a pap

A

o Spatula should be rotated at least 360 degrees around ectocervix
o Endocervical brush should NOT be turned MORE than 180 degrees
o Broom should be rotated 5x around ectocervix
o Brush does not remain in the collection device

28
Q

Can you do surveillance with cytology?

A

o Surveillance with cytology alone is acceptable only if testing with HPV or co-testing is not feasible.
 Cytology is less sensitive than HPV testing for detection of precancer and is therefore recommended more often.
- do this in 6 month intervals if HPV calls for annual testing
-recommended annually when HPV suggested Q 3 years

29
Q

Frequency of Pap testing

A

i. Ages 21-29: Pap every 3 years
**ACOG/ASCCP allow for primary hrHPV testing q 5 years in persons age 25-29
ii. Ages 30-65: Cytology (pap) every 3 years OR Primary hrHPV testing every 5 years OR Cytology (pap) + hrHPV (co-testing) every 5 years

30
Q

When can you stop doing a pap?

A

a. Age 65 with:
i. 2 consecutive negative HPV tests
ii. 2 consecutive negative co-tests
iii. 3 consecutive negative cytology tests within the past 10 y, with the most recent test occurring within the recommended interval for the test used
b. Note: ASCUS cytology with HPV negative are NOT sufficient to exit screening
c. Patients with prior CIN 2-3 require screening with HPV testing or co-testing q 3 years for 25 years s/p tx even if this extends beyond 65

31
Q

Who must continue with pap beyond 65 and cannot stop?

A

a. Exposed to DES (diethylstilbestrol) in utero
b. Immunocompromised
i. HIV
ii. Organ transplant
c. Previous hx cervical CA or high grade cervical lesion
d. Person undergoing surveillance for abnormal results

32
Q

Pap screening guidelines for total hysterectomy

A

a. Total hysterectomy – never had CIN 2+  routine cytology screening and HPV testing should be discontinued
b. Hx of CIN 2/3 prior to hysterectomy  at risk for recurrent CIN of the vaginal cuff
i. HPV based testing Q3 years for 25 years post treatment

33
Q

What age do you start HPV testing?

A

25

34
Q

ASCUS with + HPV - what to do?

A

 Refer to colposcopy vs repeat in 1 year based on patient hx

35
Q

o ASCUS with (-) HPV

A

 Repeat co-testing in 3 years if prior benign hx

36
Q

ASC-H next steps

A

o Colposcopy regardless of age or HPV status

37
Q

LSIL-H next steps

A

o Colposcopy regardless of age or HPV status

38
Q

HSIL next steps

A

o Colposcopy regardless of age or HPV status

39
Q

What if there are endometrial cells?
-Premenopausal
-Post menopausal
-Post-hysterectomy

A

pre-menopausal: Benign appearing endometrial cells, endometrial stomal cells, histiocytes consistent with LMP  no further workup

Post-menopausal: Benign endometrial cells on pap  Endometrial sampling IS INDICATED

Post-hysterectomy: Benign glandular cells  no further workup

40
Q

atypical glandular cells (other than atypical endometrial cells) next steps?

A

 Colposcopy w/ endocervical sampling (if not pregnant)
* If >= 35 or <35 and risk of endometrial neoplasia  include endometrial biopsy

41
Q

CIN-1 next steps

A
  • HPV test in 1 year
  • persistent CIN-1 for 2 years –start to think excision if over 25
42
Q

CIN-2 next steps

A

o Tx is indicated except when young or pregnant or want to become pregnant  can have them come back in 6 month intervals for pap and colposcopy

43
Q

CIN-3 - can you treat in pregnancy?

A

Do not treat during pregnancy

44
Q

Excisional treatment for CIN2/3

A

o LEEP
 Might leave cauterization areas that make it hard to
ensure clean margins
o Cold knife conization
 Performed in the OR under anesthesia
 Do this if you need to ensure clean margins

45
Q

POST CIN treatment
-over 25
-under 25

A

o >= 25 HPV based testing at 6 mos
 HPV +: colpo and biopsy
 HPV (-): HPV based testing annually Q3 years
o < 25  cytology at 6 mos
 Abnormal  colpo and biopsy
 Normal  continue cytology q 6 mos. for 3 years
* Reaches 25  transition to HPV testing

46
Q

Follow up for CIN with positive margins

A

o HPV testing at 6 mos
 + – colpo and biopsy
 (-) – HPV annually for 3 years

Women's Health Theory (7 decks)

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