cervical cytology

Question 1

what is the second most common cancer in women in less developed regions

Answer 1

cervical cancer

Question 2

What are the risk factors for cervical cancer

Answer 2

Early onset of sexual activity
multiple partners
long term use of OCP
nutrition deficiency
immunosuppression
lack of HPV vaccine***

Question 3

Which women in developed countries are at highest risk for cervical cancer

Answer 3

those who are not adequately screened

Question 4

What is the median age of cervical cancer diagnosis

Answer 4

50

*most frequently between 35-44

Question 5

what is the median age at death for women diagnosed with cervical cancer

Answer 5

59

Question 6

What are the 2 main types of cervical cancer

Answer 6

SCC
adenocarcinomas

Question 7

Where does SCC occur in cervical cancer

Answer 7

arise in squamous epithelial cells of the cervix

Question 8

Where of adenocarcinomas arise in cervical cancer

Answer 8

arise in glandular cells of the endocervix

Question 9

Which type of cervical cancer is much harder to identify on Pap smears

Answer 9

adenocarcinomas

Question 10

What is the best way to treat cervical cancer

Answer 10

prevention

Question 11

Which gender is the HPV vaccine intended for

Answer 11

both males and females

Question 12

Which gender is the main carrier of HPV for transmission

Answer 12

males

Question 13

What is the purpose of screening tests like Pap smears for cervical cancer prevention

Answer 13

it helps identify premalignant lesions as well as invasive disease

Question 14

What are the methods for screening for cervical cancer

Answer 14

Pap (cytology)
HPV testing for high risk

Question 15

What area of the cervix is evaluated during cervical cancer screenings

Answer 15

Transformation zone between endo and ecto cervix

Question 16

How long does HPV take to go away

Answer 16

generally 6-24 months without treatment

*especially if vaccinated

Question 17

What are ablative therapy options

Answer 17

electrical loop excision (LEEP)
cryotherapy
cone biopsy

Question 18

What are some cervical screening complications

Answer 18

cervical stenosis
infertility
cervical incompetence
PROM

Question 19

What is the object of the cervical screening process

Answer 19

You want a representative cell sample
AKA: need cells from transformation zone and endocervical canal

Question 20

What is the main cause of cervical cancer

Answer 20

HPV

Question 21

Which cancers are cause from HPV

Answer 21

Cervical
anal
oropharyngeal

Question 22

What are the main high risk types of HPV

Answer 22

16 and 18
*carcinogenic

Question 23

What are the different types of HPV vaccines

Answer 23

Gardasil 9 ** (9-26y/o)

Question 24

When should HPV vaccine be given

Answer 24

ideally during recommended ages because its most effective

Question 25

Which patients should get 2 doses of the HPV vaccine

Answer 25

those who get their first dose before there 15th birthday

Question 26

Which patients should get 3 doses of the HPV vaccine

Answer 26

those who get their first done on or after their 15th birthday

Question 27

Which cells within the cervix are the most vulnerable to mutagens like HPV

Answer 27

Cells in the metaplasia

Question 28

What is included in an optimal cervical cancer screening

Answer 28

it includes the entire transformation zone

Question 29

What type of screening prep is required for HPV typing

Answer 29

liquid based cytology *Not conventional pap

Question 30

What are the FDA approved liquid based cytology paps

Answer 30

thinprep surepath

Question 31

What is NILM

Answer 31

negative for intraepithelial lesion of malignancy

Question 32

What are some cytology findings with Pap smears

Answer 32

atypical glandular cells suspicion for invasive disease

Question 33

What are some histology finding with Pap smears

Answer 33

invasive carcinoma and the different grading

Question 34

What is SIL

Answer 34

Squamous intraepithelial lesion *general term for abnormal growth of squamous cells on the surface of the cervix

Question 35

What are the two types of SIL

Answer 35

Low grade high grade

Question 36

What is low grade SIL

Answer 36

early changes in size, shape, and number of cells from surface of the cervix

Question 37

What is high grade SIL

Answer 37

large number of precancerous cells

Question 38

What do atypical glandular cells always indicate the need for

Answer 38

colposcopy endocervical curettage AND endometrial biopsy

Question 39

What is HPV co-testing

Answer 39

Adjunct testing with cytology

Question 40

What is HPV reflex testing

Answer 40

abnormal findings on cytology

Question 41

What are the different types of HPV testing

Answer 41

1. test that detects the presence / absence of 13-14 HPV subtypes 2. HPV genotyping and report presence/absence of 16 or 18

Question 42

What is HPV 18 associated with

Answer 42

cervical adenocarcinoma

Question 43

When should cervical cancer screenings be started

Answer 43

21 regardless of sexual activity

Question 44

What is the screening interval for 21-30 y/o

Answer 44

Cytology only *q3 years if normal

Question 45

What is the screening interval from 30-65

Answer 45

Pap plus HPV *q5 years if normal

Question 46

How does a supracervical hysterectomy change the cervical screening intervals

Answer 46

it doesn't... stays the same

Question 47

When should cervical cancer screening be started

Answer 47

25y/o

Question 48

What is the preferred test for cervical cancer

Answer 48

HPV

Question 49

When can you stop cervical cancer screenings at 65

Answer 49

2 negative, consecutive co-tests 3 negative Pap tests in the last 10y

Question 50

If a patient is over 65 and reports having a new sexual partner, do you resume cervical cancer screenings

Answer 50

no *risk is low and colposcopy is more difficult to preform

Question 51

What is an exception for continuing cervical screenings after 65

Answer 51

women exposed to DES in utero require years screening, even after TAH/TVH

Question 52

How long after a TAH/TVH for high grade lesions, should cervical screenings be preformed regardless of age

Answer 52

20 years

Question 53

If there is an abnormal cytology or positive HPV test, what is the gold standard for next step workup

Answer 53

Colposcopy

Question 54

What is LEEP used for and what is it

Answer 54

CIN 2,3 Excision of entire transformation zone with an electrified loop

Question 55

What is the purpose of a LEEP procedure

Answer 55

obtaining a diagnostic tissue sample to exclude or identify invasive disease