Cervical cytology, HPV and Neoplasia -Foster

Question 1

What can lead to an increased risk of cervical dysplasia?

Answer 1

Persistent HPV infection

immunosuppression and smoking

Question 2

Almost all cases of cervical cancer are caused by _____

Answer 2

high risk HPV (16, 18, 31, 33, 35)

Question 3

What is the lifetime risk for a woman to be infected with HPV? How is this normally treated?

Answer 3

85%

normally clears on its own within 24 months

Question 4

What are the guidelines for cervical cytology screening? When should you begin, how often should you screen, when should you stop screening?

Answer 4

Begin at age 21

Cytology ALONE every THREE YEARS age 21-29

After age 30, cytology plus HPV every 5 years (preferred) or cytology only every 3 years.

If HIV positive, immunosuppressed, or DES exposed, screen more frequently.

Age-based routine screening for at least 20 years after treatment of CIN 2 or higher

Stop at age 65 if no history of CIN 2 or higher

Question 5

What are the potential pap smear results? When is a colposcopy recommended?

Answer 5

ASCUS=atypical squamous cells of uncertain significance (if >25 yo and HPV +, do a colposcopy)

ASC-H= cannot exclude high-grade lesion –> colposcopy

LSIL (low grade squamous intraepithelial lesion) or ASCUS (age 21-24): repeat cytology in 1 year.
If worse–> colposcopy.
if negative–> repeat in 1 year

Question 6

Where does a colposcopy have to be done for it to be satisfactory?

Answer 6

at the squamo-columnar junction

Question 7

What is an abnormal colposcopy finding?

Answer 7

aceto-whitening seen in the epithelium

Question 8

What should be done if a HSIL shows a biopsy with CIN 2, 3?

Answer 8

ablation of the excision

can do a repeat colposcopy and cytology for 12 months in young women with CIN 2

can do immediate excision for highly suspicious CIN 2, 3

Question 9

What is AGUS? What should be done in these patient if they are > 30 or have risk factors?

Answer 9

atypical glandular cells –> more concerning than ASCUS

colposcopy PLUS biopsy

Question 10

Do obvious lesions need to have a colposcopy before being biopsied?

Answer 10

NO!

pap smears have a high false negative rate in invasive disease so cut that shit out now (biopsy without cytology is OK)

Question 11

What are the 2 vaccines available for HPV? When are these most effective?

Answer 11

Approved for females age 9 – 26

Gardasil – quadrivalent vaccine: 6, 11, 16, 18

Cervarix– bivalent 16, 18.

Will not prevent all cervical ca; most effective if given before sexually active