Cervical Disorders Flashcards
Describe the presentation of nabothian cysts
*Glandular material becomes trapped
- Benign
- Asymptomatic (seen on speculum exam)
Nabothian cysts: tx
excision is not required
Cervical polyps: clinical presentation
- post-coital bleeding (maybe)
- abnormal uterine bleeding (maybe)
- Benign
Cervical polyps: tx
polypectomy if symptomatic
Describe the difference in cells from the endo and ectocervix
Ectocervix - stratified squamous epithelial
Endocervical - single layer mucin-producin columnar cells
Adequate sampling requires adequate sampling from where?
endocervical sampling
Between HPV 16 and 18, the more common types to cause cancer, which causes squamous or adenocarcinoma more often?
HPV 16 –> Squamous cell carcinoma
HPV 18 –> Adenocarcinoma
Low risk HPV types
6 and 11
What are the biggest risk factors for HPV infection
Multiple sex partners** Smoking* Sexually active at early age History of STDs History of VIN and VAIN
What does Gardasil 9 protect against
HPV 6, 11, 16, 18, (31, 33, 45, 52, 58)
For a patient 21-29yrs, what type of screening test and frequency is recommended?
Pap test every 3 years
For patients over 30, what is the recommended screening test and frequency?
Pap test and HPV screen every 5 years
or
Pap test every 3 years
When do pap smears need to start?
age 21 (doesn’t matter if sexually active)
Do you need to screen for HPV in patients 21-24?
NO!!!!! (can consider it at age 25)
What should be included in adolescent patient encounters?
- Contraceptive counseling
- STI screening (urine sample)
- HPV vaccination education/administation
- Safe sex practices
Describe the high risk patients who need to be screened every year for cervical cancer
- HIV (every 6 months the year of diagnosis, then every year)
- Immunocompromised
- Hx of cervical cancer
- History of CIN II/III
- Exposure to diethylstilbestrol in utero
When does screening for cervical cancer stop?
65
(Evidence of 3 prior consecutive negative results with cytology. but can’t have history of CIN II/III within last 20 years, Doesn’t apply to high risk pts.
When does screening stop for patients with hysterectomy?
at time of surgery
if they have no history of cervical cancer and no history of CIN II/III within 20 years
What is the next best step if doing a speculum exam and you see an abnormal cervical lesion?
biopsy! (pap smear is for screening, if you don’t see anything suspicious)
If your patient is between 21-24, what is the next best step for finding atypical cells of undertermined significance?
repeat Pap smear/cytology in 1 year
If your patient is 25+ and you find atypical cells, what is the next clinical step?
If abnormal pathology, need a reflex HPV DNA**
If HPV DNA is negative–> repeat co-testing in 3 years
If HPV DNA is positive–>colposcopy
What is the next clinical step for a 21-24 year old patient with a low grade squamous intraepithelial lesion?
repeat Pap smear/cytology in 1 year (same as ASCUS)
What is the next clinical step for a low grade squamous intraepithelial lesion in a patient 25+?
Colposcopy
or
Repeat Pap + HPV in 1 year if HPV DNA test is negative
What is the next clinical step for a patient with high grade lesion (CIN II-AIS (adenoscarinoma insitu))?
Colposcopy
