cervical cytology Flashcards
what is the second most common cancer in women in less developed regions
cervical cancer
What are the risk factors for cervical cancer
Early onset of sexual activity
multiple partners
long term use of OCP
nutrition deficiency
immunosuppression
lack of HPV vaccine***
Which women in developed countries are at highest risk for cervical cancer
those who are not adequately screened
What is the median age of cervical cancer diagnosis
50
*most frequently between 35-44
what is the median age at death for women diagnosed with cervical cancer
59
What are the 2 main types of cervical cancer
SCC
adenocarcinomas
Where does SCC occur in cervical cancer
arise in squamous epithelial cells of the cervix
Where of adenocarcinomas arise in cervical cancer
arise in glandular cells of the endocervix
Which type of cervical cancer is much harder to identify on Pap smears
adenocarcinomas
What is the best way to treat cervical cancer
prevention
Which gender is the HPV vaccine intended for
both males and females
Which gender is the main carrier of HPV for transmission
males
What is the purpose of screening tests like Pap smears for cervical cancer prevention
it helps identify premalignant lesions as well as invasive disease
What are the methods for screening for cervical cancer
Pap (cytology)
HPV testing for high risk
What area of the cervix is evaluated during cervical cancer screenings
Transformation zone between endo and ecto cervix
How long does HPV take to go away
generally 6-24 months without treatment
*especially if vaccinated
What are ablative therapy options
electrical loop excision (LEEP)
cryotherapy
cone biopsy
What are some cervical screening complications
cervical stenosis
infertility
cervical incompetence
PROM
What is the object of the cervical screening process
You want a representative cell sample
AKA: need cells from transformation zone and endocervical canal
What is the main cause of cervical cancer
HPV
Which cancers are cause from HPV
Cervical
anal
oropharyngeal
What are the main high risk types of HPV
16 and 18
*carcinogenic
What are the different types of HPV vaccines
Gardasil 9 ** (9-26y/o)
When should HPV vaccine be given
ideally during recommended ages because its most effective
Which patients should get 2 doses of the HPV vaccine
those who get their first dose before there 15th birthday
Which patients should get 3 doses of the HPV vaccine
those who get their first done on or after their 15th birthday
Which cells within the cervix are the most vulnerable to mutagens like HPV
Cells in the metaplasia
What is included in an optimal cervical cancer screening
it includes the entire transformation zone
What type of screening prep is required for HPV typing
liquid based cytology
*Not conventional pap
What are the FDA approved liquid based cytology paps
thinprep
surepath
What is NILM
negative for intraepithelial lesion of malignancy
What are some cytology findings with Pap smears
atypical glandular cells
suspicion for invasive disease
What are some histology finding with Pap smears
invasive carcinoma and the different grading
What is SIL
Squamous intraepithelial lesion
*general term for abnormal growth of squamous cells on the surface of the cervix
What are the two types of SIL
Low grade
high grade
What is low grade SIL
early changes in size, shape, and number of cells from surface of the cervix
What is high grade SIL
large number of precancerous cells
What do atypical glandular cells always indicate the need for
colposcopy
endocervical curettage
AND
endometrial biopsy
What is HPV co-testing
Adjunct testing with cytology
What is HPV reflex testing
abnormal findings on cytology
What are the different types of HPV testing
- test that detects the presence / absence of 13-14 HPV subtypes
- HPV genotyping and report presence/absence of 16 or 18
What is HPV 18 associated with
cervical adenocarcinoma
When should cervical cancer screenings be started
21 regardless of sexual activity
What is the screening interval for 21-30 y/o
Cytology only
*q3 years if normal
What is the screening interval from 30-65
Pap plus HPV
*q5 years if normal
How does a supracervical hysterectomy change the cervical screening intervals
it doesn’t… stays the same
When should cervical cancer screening be started
25y/o
What is the preferred test for cervical cancer
HPV
When can you stop cervical cancer screenings at 65
2 negative, consecutive co-tests
3 negative Pap tests in the last 10y
If a patient is over 65 and reports having a new sexual partner, do you resume cervical cancer screenings
no
*risk is low and colposcopy is more difficult to preform
What is an exception for continuing cervical screenings after 65
women exposed to DES in utero require years screening, even after TAH/TVH
How long after a TAH/TVH for high grade lesions, should cervical screenings be preformed regardless of age
20 years
If there is an abnormal cytology or positive HPV test, what is the gold standard for next step workup
Colposcopy
What is LEEP used for and what is it
CIN 2,3
Excision of entire transformation zone with an electrified loop
What is the purpose of a LEEP procedure
obtaining a diagnostic tissue sample to exclude or identify invasive disease
