Cervical Disease and Neoplasia

Question 1

what are risk factors for cervical cancer?

Answer 1

majority related to HPV exposure and include early onset sexual history, multiple partners, sexual partner with multiple partners, history of HPV or other sexually transmitted diseases, immunosuppression, smoking, low socioeconomic status and lack of regular Pap tests

Question 2

how is ASCUS managed?

Answer 2

include performing HPV DNA testing or repeat cytology at 12 months following abnormal Pap; if HPV testing negative then routine screening can resume in 3 years; if HPV positive or repeat cytology at 12 months reveals ASCUS or higher, colposcopy should be performed; for women 21 to 24 if HPV positive then repeat cytology at 12 months recommended with colpo only if cytology reveals ASC-H, AGC, or HSIL

Question 3

What are some signs of involvement of parametria(Stage II)?

Answer 3

physical exam with fixation of the uterus and thickening of the rectovaginal septum and back pain

Question 4

what is a white plaque found on the cervix?

Answer 4

leukoplakia; should be biopsied directly or under colposcopic guidance as soon as possible regardless of Pap results

Question 5

What are punctuations and mosaicism?

Answer 5

new blood vessels on end and on their sides, respectively

Question 6

What are atypical vessels?

Answer 6

such as those with hairpin shapes or larger vessels branching off from smaller ones, usually represent greater degree of angiogenesis and usually more aggressive lesion

Question 7

what is ectropion?

Answer 7

appears as a reddish ring of tissue surrounding the external os that is an area of columnar epithelium that has not yet undergone squamous metaplasia

Question 8

after cervical conization performed, when should cotesting be performed?

Answer 8

cotesting at 12 and 24 months

Question 9

How long does the development of cervical cancer take from the time of exposure?

Answer 9

typically at least 15 years

Question 10

what is microinvasive cervical cancer?

Answer 10

invades less than 3mm past basement membrane

Question 11

what is carcinoma in situ?

Answer 11

involves entire epithelium to basement membrane but not past

Question 12

When can cryotherapy be used?

Answer 12

to treat cervical dysplasia once cancer has been completely ruled out and entire lesion can be visualized

Question 13

What are guidelines for cervical cancer screening?

Answer 13

• start at 21 years
• 21 to 29yo should have pap every 3 years
• 30 to 65yo should have pap and HPV co testing every 5 years if none have been abnormal previously or pap test alone every 3
• stop having screening at 65 if they do not have history of moderate or severe dysplasia or cancer and have had either 3 negative pap tests in a row or 2 negative co test results in a row within past 10 years with most recent in past 5 years