Cervical disorders Flashcards
What is a nabothian cyst?
cystic structure that forms when columnar epithelium is covered by squamous epithelium (glandular material becomes retained)
Describe nabothian cysts
- translucent or yellow
- benign
- asymptomatic
- excision not required
Sx of cervical polyps?
Tx?
benign
-may cause post-coital bleeding or abnormal uterine bleeding
Polypectomy for symptomatic patients
What is the transformation zone?
- squamo-columnar junction
- metaplastic squamous epithelium
adequate cervical sampling requires presence of?
endocervical sampling
What cervical tissue is very susceptible to HPV virus compared to squamous tissue?
transformation zone/metaplastic tissue
HPV 16 causes what kind of cervical CA MC?
HPV 18 causes what kind?
16= squamous cell carcinoma
18= adenocarcinoma
Low risk types of HPV?
High risk?
Low: 6, 11
High: 16, 18
Risk factors for HPV?
- multiple sexual partners
- smoking
- immunosuppression
- early onset sexual activity
- hx of STD
- long-term oral contraceptive use
- multiparity
Under age 25 should not receive what type of screening?
HPV
When do you start screening for cervical CA?
age 21 despite the age of sexual debut
Do most women w/ HPV produce neoplastic change?
NO
Nearly all cases are cleared w/in 1-2 yrs w/o producing neoplastic change
What screenings should be done in adolescents?
- contraceptive counseling
- STI screening
- HPV vaccine/education
- Safe sex practices
- No Pap unless in high-risk population
For cervical CA screening, women aged 21-29 should get what
-Cytology every 3 years
NO HPV testing
For cervical CA screening, women aged 30-64 should get what
-Cytology (+) HPV DNA every 5 yrs
OR
-Cytology alone every 3 yrs
Patients who are HIV +, immunocompromised, hx of cervical CA, hx of CIN II/III, or have exposure to DES need a cervical CA screening how frequently?
every year
When does cervical screening stop?
Age 65 if: In past 10 yrs
-pt has 3 prior consecutive cytology results
OR
-2 consecutive negative co-testing results
(most recent has to be w/in 5 yrs, cannot have hx of CIN 2/3 in 20 yrs)
If a 66 year old women with no PMHx of CIN 2/3 or + cytology has a new sexual partner, do you perform a cervical screening?
No!
stop at age 65
If a women has a hysterectomy, when can you stop cervical CA screenings?
at time of surgery if cervix is removed
&
(was performed for benign dz & no hx of CIN2+)
when performing a speculum exam & an abnormal cervical lesion is noted, what do you do?
perform a BIOPSY
NOT a Pap smear
Is a Pap smear a diagnostic or screening tool?
Biopsy?
Pap= screening
Biopsy= diagnostic
What is an ASC-US?
Atypical cells of undetermined significance
If a pt age 21-24 has ASC-US, what do you do?
repeat cytology in 1 yr
If a pt age 25+ has ASC-US, what do you do?
Explain what to do next based on results
Must reflex to HPV DNA
Negative= normal cytology, repeat co-test in 3 yrs
Positive HPV= colposcopy
What is LSIL
Low grade squamous intraepithelial lesion
If a pt age 21-24 has LSIL, what do you do?
Explain what to do next based on results
Repeat cytology in 1 yr
+ASC-H/HSIL: colposcopy
- ASCUS/LSIL: cytology 1 yr
another year later
+ASC-H/HSIL= high grade lesion= colposcopy
If a pt age 25 has LSIL, what do you do?
refer for colposcopy despite HPV result
OR
Repeat co-testing in 1 yr is HPV testing is neg
If a pt has HSIL/ASC-H, what do you do?
assume HPV present
refer for colposcopy
(lesions usu. c/w CIN II/III)
If you get a cytology result back of negative cytology, no endocervical cells, what do you do in a 21-29 yo pt?
routine screening- repeat PAP in 3 yrs, no HPV
If you get a cytology result back of negative cytology, no endocervical cells, what do you do in a >30 yo pt?
perform HPV DNA test
If you get a cytology result of “unsatisfactory cytology”, what do you do if no HPV testing ordered?
If HPV testing was ordered?
Not ordered= repeat Pap 2-4 mo
HVP testing done= if negative repeat Pap in 2-4 mo
A 30+ yo woman w/ negative cytology but + HPV… what do you do?
- Colposcopy if genotype 16/18
- repeat co-testing in 12 mo if not genotype 16/18
What is positive HPV DNA test (x2) a/w?
21% chance it will be CIN II/III w/in 36 mo
What is considered a satisfactory colposcopy exam?
complete visualization of transformation zone
When is LEEP indicated in age 21-24?
- persistent HSIL (24 mo)
- CIN 2+
- Unsatisfactory colposcopy
If pt is 25+ w/ HSIL/ASC-H, colposcopy or LEEP?
If colposcopy done and HSIL/CIN 1 –> Keep or co-testing
If colposcopy done and HSIL/CIN 2+–> LEEP
LEEP is contraindicated in who?
- if invasion is suspected
- glandular abnormality on Pap
- Pt is pregnant
Cervical squamous cell CA is most a/w what type of HPV?
strain 16
Cervical adenoma is most a/w what type of HPV?
strain 18
Characteristics of cervical squamous cell cancer
- prevalence 65-85% and falling!
- microinvasion (<3 mm)
- invasive (>3 mm or visible)
Prevalence and types of Cervical adenocarcinoma
- Prevalence 1-25% and rising
- Endocervical, Endometrial, Clear Call, Adenoid Cystic
Presentation of cervical CA
ASYMPTOMATIC
MC sx= abnormal vaginal bleeding
- postcoital bleeding
- unilateral pelvic pain w/ radiation to thigh
- vag discharge
