Cervical Dysplasia Flashcards by Amy Stites

what is cervical dysplasia?

Dysplasia defined is abnormal growth or development of cells, tissues, or organs.
Pap smear - screen for cervical dysplasia
The pap indicates the amount of “abnormal cell growth” occurring on the cervix.

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Why is cervical cancer on the rise?

Mostly because we are screening for it more and younger, before symptoms arise.

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What are the two types of cervical cancer? Which is more common?

80-90% are Squamous Cell Carcinoma (ectocervical)

10-20% are Glandular or Adenocarinoma
Seeing greater numbers adenocarcinoma and adenosquamous carcinoma (endocervical)

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T/F: worldwide, cervical cancer is the 2nd most common in women

true

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what is the major factor contributing to cervical cancer?

having never been screened for it

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What is the median age of diagnosis with cervical cancer?

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When should screening for cervical cancer begin?

age 21 (regardless of sexual activity)

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How often should a pap smear be done?

age 21-29, every 3 years
age 30-65, every 3 years
(assuming they are negative)

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When is cytology and HPV indicated together?

age 21-29, co testing is not recommended.

age 30-65, every 5 years
unless abnormal results

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When is appropriate to stop screening for cervical cancer?

> 65

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What are some of the risk factors for cervical cancer?

Young age at first coitus (<20 yr)
Multiple sexual partners
Sexual partner with multiple sexual partners
Immunocompromised patient
DES exposure (diethylstilbestrol);1943-1971 (prevent miscarriage)
Young age at first pregnancy
Smoking
Lower socioeconomic status
High parity

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Describe the two types of pap smears available, and the benefits of each.

Conventional Pap Smears
available since 1940’s
Sensitivity 50-60%
Cost: $31

Liquid-based (ThinPrep) Pap Smear:
Thin-Prep, Sure Path
Available since mid-1990’s
Sensitivity approx. 30-60% > than conventional
Cost: $50-60
HPV DNA testing

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What are the two formats used for reporting pap smear results and WHAT do they tell you?

Bethesda System (National CA Institute)
Classification according to the degree of cell abnormality
AMOUNT

CIN System
Classification of how far below the surface of the cervix the cells are affected
DEPTH

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What are the different categories for the Besthesda system?

Squamous Cell (Ectocervical cells)
ASC-US: Atypical squamous cells of undetermined significance
ASC-H: Atypical squamous cells-cannot exclude
high grade squamous intraepithelial lesion
LGSIL: Low grade squamous intraepithelial lesion (CIN 1 and 2)
HGSIL: High grade squamous intraepithelial lesion
(CIN 3 and CIS)
CIS: Carcinoma in situ
Squamous Cell Cancer

Glandular Cell (Columnar cells)
AGC-US: Atypical glandular cells of undetermined significance (endocervical canal)
Can be normal in post menopausal people but always need to do an EMB (endometrial biopsy)
AIS: Adenocarcinoma in situ
Adenocarcinoma

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What is ASC-US and ASC-H?

Atypical squamous cells of undetermined significance

ASC-H: Atypical squamous cells-cannot exclude
high grade squamous intraepithelial lesion

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What is LGSIL? HGSIL? CIS?

LGSIL: Low grade squamous intraepithelial lesion (CIN 1 and 2)
HGSIL: High grade squamous intraepithelial lesion
(CIN 3 and CIS)
CIS: Carcinoma in situ

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What is AGC-US? AIS?

AGC-US: Atypical glandular cells of undetermined significance (endocervical canal)

AIS: Adenocarcinoma in situ

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Describe the CIN system:

CIN I/Mild Dysplasia (includes HPV 
    effect)
CIN II/Moderate Dysplasia
CIN III/Severe Dysplasia/CIS
Cancer

How do you relate the results of Besthesda and CIN?

Mild = CIN I = LGSIL
Moderate = CIN II = LGSIL/HGSIL
Severe/CIS = CIN III = HGSIL

What are some ways that you can get abnormal pap results that are actually BENIGN?

Infection:
  treat accordingly-no repap needed
Atrophic:
  vaginal estrogen and repeat in  6 month/year
ASCUS -high risk HPV (-):
  12 months
  if repeat pap is same ? colposcopy

What are NON-benign presentations of pap results? is a colposcopy indicated?

ASCUS &+HPV,AGUS,LGSIL,HGSIL/CIS

need COLPOSCOPY

how soon should be a colposcopy be scheduled after menses?

1-2 weeks

If patient is of child-bearing age, you should always test for ______ before doing a colposcopy?

pregnancy!!

what will a colposcopy tell you?

acetic acid will turn abnormal areas white

If a pregnant woman has an abnormal pap smear, what is the goal?

rule out invasive cancer.

When is treatment initiated in pregnant woman with abnormal pap smear?

treatment is deferred until 6 weeks postpartum unless cancer. a very small (.4%) actually progress to cancer.

Do most regress after delivery of the baby?

yes

Describe a colposcopy in pregnancy:

1. Colposcopy with biopsy before 12 wks (No ECC done , to see if HGSIL or CA because it can dilate the cervix and cause a miscarriage ) 2. ASCUS HPV (+) colposcopy or defer till PP 3. Mild dysplasia colposcopy or defer till PP 4. Mod/Severe dysplasia: colp early, repap w/ colp at 20 wks (No biopsies or ECC done at 20 wks - unless obvious CA)

What treatment options are available?

Cryotherapy: Effective for small non-invasive lesions freezing cervix with liquid NO2 probe; depth of 4-5 mm.; CO2 Laser Ablation: Larger visible lesions Burning cervix with CO2 laser; depth of 6-7 mm Need anesthesia LEEP/LEETZ( loop electrical excision proc.): Excisional biopsy for CIN Cuts to depth of 6-10 mm. Tissue to pathology Conization: For severe dysplasia (CIN III) Cold-knife cone (surgical blade) or LEEP Used for areas that involve ecto/endo tissue Hysterectomy

How will you treat for small non-invasive lesions?

cryotherapy

How will you treat for larger, visible lesions?

c02 laser ablation

How will you treat for CIN

LEEP

How will you treat for severe dysplasia?

Conization

What is the definitive treatment?

hysterectomy is serious enough

What are 70% of cervical cancers due to?

HPV 16 and 18 | high risk

T/F: most HPV infections lead to cancer

FALSE | most new infections will clear within one year, and 95% by 2 years.

What does HPV persistence signify?

Infection detected at more than one visit (usually 4-6 months apart) Most important predictor of high grade cervical cancer precursors

What is a reflex HPV?

it is added onto a pap smear for high risk patients. It determines the DNA sequence

In what population is a co-test indicated?

>30 years old

What is cervista

only tests for HPV 16 and 18

Describe the HPV immunizations available

``` CERVARIX: Indicated for the prevention of cervical cancer Covers HPV strains 16 and 18 Approved for males/females ages 10-25 3 dose series, 0, 1, and 6 months Not to be given in pregnancy ``` GARDASIL: Same as other except covers types 6,11,16,18

Who should get the HPV vaccine?

Indicated in girls and women;boys and men ages 9-26 for the prevention of the following diseases caused by HPV types 6, 11, 16, and 18: 1. Cervical cancer 2. Cervical, vaginal and vulvar precancerous or dysplastic lesions 3. Genital warts (condyloma acuminata) (boys and men) Ideally vaccine should be administered before onset of sexual activity, but males and females who are sexually active should still be vaccinated.

Is the vaccine effective against existing disease?

evidence does not show that Males and Females not yet sexually active can be expected to have the full benefit of vaccination Sexually active males and females may not have full benefit because they may have been infected with vaccine HPV types, however:

HPV vaccine for pregnant people:

Initiation of the vaccine series should be delayed until after completion of pregnancy If pregnant after initiating the vaccination series, remaining doses should be delayed until after pregnancy If a vaccine dose administered during pregnancy, no indication for intervention Exposures to vaccine in pregnancy should be reported (800) 986-8999