Cervical Cytology

Question 1

How does cervical cancer impact low- and middle-income countries?

Answer 1

Very high mortality rate, accounting for 85% of all cervical cancer deaths

Poor screening practices lead to worse outcomes

Question 2

What is the number one risk factor for cervical cancer?

Answer 2

Early onset of sexual activity

Question 3

Does risk of cervical cancer decrease with age?

Answer 3

Yes

Question 4

What are some risk factors for cervical cancer?

Answer 4

Early onset of sexual activity
Multiple partners
Long-term OCP use
Low socioeconomic status
Nutritional deficiencies
Immunosuppression
Tabacco use
Lack of HPV vaccine

Question 5

What cohorts are less likely to be screened for cervical cancer?

Answer 5

Minorities
Low SES
Foreign born
Limited healthcare access
Uninsured

Question 6

What are the two main types of cervical cancer?

Answer 6

Squamous cell carcinoma
Adenocarcinomas

Question 7

Where does cervical squamous cell carcinoma arise from?

Answer 7

Squamous epithelial cells of the cervix

Question 8

Where does cervical adenocarcinoma arise from?

Answer 8

Glandular cells of the endocervix (much harder to identify with pap testing)

Question 9

What risk reduction measures for preventing cervical cancer?

Answer 9

Sex Ed
Contraceptives (condoms)
HPV vaccine for males and females

Question 10

What is the best treatment for cervical cancer?

Answer 10

Prevention

Question 11

What are the screening methods for cervical cancer screening?

Answer 11

Pap test (cytology)
HPV testing

Question 12

What area of the vagina is at greatest risk for neoplasia?

Answer 12

Squamocolumnar junction

Question 13

Where are cells obtained from during cervical cancer screening?

Answer 13

External surface of cervix (ectocervix) and cervical canal (endocervix)

*This allows evaluation of the squamocolumnar junction (transformation zone)

Question 14

Do HPV infections clear without intervention?

Answer 14

Yes, especially in vaccinated women and younger women

Question 15

What are some cervical cancer screening complications?

Answer 15

Damage to the cervix which can ultimately lead to:
-Cervical stenosis
-Infertility
-Cervical incompetence
-PROM, preterm birth, low-birth weight infants, perinatal death

Question 16

In what motion should cells be obtained in cervical cancer screening?

Answer 16

Circumferentially

Question 17

What are the two most common HPV strains causing cervical cancer?

Answer 17

16 and 18

Question 18

What form of HPV vaccine is currently on the market?

Answer 18

Gardasil 9 (9-valent HPV vaccine)

Question 19

Due to high effectiveness, the HPV vaccine is recommended to be received when?

Answer 19

Ages 11-12

*Most effective if received before loss of virginity

Question 20

Is a friable cervix a normal finding?

Answer 20

Yes, it does not indicate cancer

Question 21

How can you prevent bleeding during cervical sampling?

Answer 21

Obtain endocervix sample prior to extocervix and rotate brush 180 degrees 5 times

Question 22

Can HPV typing be done on conventional pap test?

Answer 22

No, needs to be liquid based cytology pap

Question 23

Atypical glandular cells always indicates need for what further testing?

Answer 23

Colposcopy
Endocervical curettage
Endometrial biopsy

Question 24

What age should cervical cancer be started?

Answer 24

21, regardless of age of initiation of sexual activity

Question 25

Who are more likely to spontaneously clear HPV and associated abnormalities?

Answer 25

Adolescents and early 20’s

Question 26

What are the current screening guidelines for cervical cancer?

Answer 26

• 21-30: Cytology only q3years (if normal)
• 30-65: either pap q3r or pap plus HPV typing q5yrs if normal

Question 27

Is cervical cancer recommended over the age of 65?

Answer 27

No, screen only if patient has a history of high-grade lesion within past 20 years

Question 28

If colposcopy comes back positive, what should be done next?

Answer 28

Loop electrosurgical excision (LEEP)

Question 29

What is being done in loop electrosurgical excision (LEEP)?

Answer 29

Excision of entire transformation zone with electrified wire loop, provides diagnostic tissue to identify invasive disease