Cervical Cytology - waldron Flashcards
what is the second most common cancer in women in less-developed regions
cervical cancer
what are risk factors for cervical cancer
early onset of sexual activity
“multiple partners”; or partner partners
long term use of OCPs
Low socioeconomic status
nutritional deficiencies
immunosuppression
tobacco use
lack of HPV vaccination
When is cervical cancer most frequently diagnosed (age)
35-44yo
mean age: 50
when is the percentage of cervical cancer deaths highest (ages)
55-64yo
mean age: 59
What can improve survival of cervical cancer
early diagnosis and treatment
What are the types of cervical cancer
Squamous cell carcinomas
Adenocarcinomas
where are squamous cell carcinomas found
arise in squamous epithelial cells of the cervix
where are adenocarcinomas found
arise in glandular cells of the endocervix - much harder to identify with Pap
how can we reduce the risk
sexual education for males and females regarding risk
use of barrier contraceptives (condoms) are not fail safe
HPV vaccines for BOTH male and females
what are the benefits of cervical cancer screening
identifies premalignant lesion as well as invasive disease
identification, appropriate treatment and surveillance
what are the methods of cervical cancer screening
Pap test (cytology)
HPV testing for high risk
what is the area at the greatest risk for neoplasia
transformation zone (squamocolumnar junction)
what are the complications of cervical cancer screenings
ablative therapies can cause damage to cervix:
-cervical stenosis
-infertility
-cervical incompetence
-premature rupture of membranes, preterm birth, low birth weight infants, perinatal death
where are the cell samples obtained from for screenings
transformation zone AND endocervical canal
what are the main cancers caused by HPV?
cervical cancer
anal cancer
oropharyngeal cancers
what type of HPV accounts for 70+% of all cervical cancers
16, 18
what are the highest risk HPV types
16 and 18
what are the low risk types of HPV
6,11, 40,42,43,44,54,61,72,81
What are the FDA approved HPV vaccines
Cervarix (taken off market due to lack of demand)
Gardasil (taken off market due to lack of demand)
Gardasil 9
who is 9-valent HPV vaccine approved for
females and males 9-45 yo
women and men who have not previously received an HPV vaccine series who are at risk
when is the HPV vaccination more effective
ideally given during recommended ages 11-12yo, through 26 yo for females and 21 for males
Who gets two doses of HPV vaccine
people who get first dose before their 15th birthday
second dose should be given 6-12 months after the first dose
who gets 3 doses of HPV vaccne
people who get their first dose on or after their 15th birthday and people with certain immunocompromising conditions
what is the squamocolumnar junction
where glandular cells from the endocervical canal meet squamous cells from vagina and ectocervix
what is the tranformation zone
cells undergoing transformation from columnar/glandular to squamous are in a state of squamous metaplasia
what are cells in metaplasia at risk of
vulnerable to mutagens like HPV
what is a pap test more sensitive for
detecting squamous lesions or malignancy than adenocarcinoma or adneocarcinoma in situ
what will help to minimize bleeding during sample collection
sampling ectocervix before the endocervix
what is the conventional pap test
cells samples using brush and/or spatula, smeared directly on slide and fixed with chemical fixative
blood and secretions can easily obscure cell visualization
what cannot be done with conventional pap test
HPV typing
what is liquid based bytology/pap
most common medium in US now
cells sampled using brush - placed in solution, centrifuged, then plated
lubricant interferes but blood does not
What are FDA approved Screening tests
ThinPrep
SurePath
What does NILM stand for
Negative for intraepithelial lesion of malignancy
what does a finding of reactive mean
inflammatory changes or radiation changes
what does a finding of ‘presence of organisms’ mean
candida, trichomonas, bacterial, vagininosis, actinomyces (IUD wearers)
What is SIL
squamous intraepithelial lesion: general term for abnormal growth of squamous cell on surface of the cervix (ASCUS)
two categories
what are the two categories of SIL
Low grade SIL (LSIL): early changes in size, shape, and number of cells from surface of cervix
High-grade SIL (HSIL): large number of precancerous cells
What are glandular cell abnormaliteis indicative for
need for colposcopy, endocervical curettage AND endometrial biopsy - cancer workup
regardless of HPV status
how many FDA approved tests for high-risk HPV
4
how many types of available HPV test
2
when should initial cervical cancer screening start
at age of 21 - regardless of age of initiation of sexual activity
what age groups of doing cytology only for screenings
21-30yo - Q3 years if normal
when is a Pap plus HPV typing recommended
30-65 years
what are the recommendations for patients with supracervical hysterectomy
continue screening appropriate to their age group and history
when can you stop screening at 65 years
if:
adequate prior screening: 2 negative consecutive co-tests OR 3 negative pap tests in last 10 years with most recent tests in last 5 years
What is a LEEP procedure
loop electrosurgical excision
excision of entire transformation zone with electrified sire loop
What are histology findings of cancer screenings
Cervical intraepithelial neoplasia (CIN)
staged 1-3
invasive carcinoma
