Cervical Dysplasia

Question 1

ASCUS

Answer 1

Atypical cells of undetermined significance
HPV (-) repeat pap in 12 months, if the same do colposcopy
HPV (+) colposcopy

Question 2

ASC-H

Answer 2

Atypical squamous cells, unable to exclude high grade lesion

colposcopy

Question 3

ASGUS

Answer 3

Atypical glandular cells of undetermined significance

endometrial biopsy and colposcopy

Question 4

LGSIL

Answer 4

Low grade squamous intraepithelial lesion (CIN 1 & 2)

colposcopy

Question 5

HGSIL

Answer 5

High grade squamous intraepithelial lesion (CIN 2, 3 & CIS)

colposcopy

Question 6

“Reactive changes”

Answer 6

Inflammation and Atrophy

Treat and repeat in 6 months

Question 7

Organisms Identified

Answer 7

Trichomonas, Fungal, Shift in flora (Bacterial vaginosis)

Treat, no repap needed.

Question 8

Pain during colposcopy

Answer 8

Recommend Advil/Tylenol approx 1 hour before procedure

Question 9

Abnormal pap during pregnancy

Answer 9

Colposcopy w/ biopsy before 12 weeks
ASCUS HPV (+) colposcopy, or defer till postpartum
Mild dysplasia colposcopy, or defer till postpartum
Mod/Severe dysplasia, colp early, repap w/ colp @ 20 weeks
No biopsies done at 20 weeks unless obvious cancer

Question 10

Small, non-invasive lesion TX

Answer 10

Cryotherapy, freezing cervix with liquid NO2; depth 4-5 mm

Question 11

Larger visible lesion TX

Answer 11

C02 Laser Ablation, burning cervix with Co2 laser; depth of 6-7 mm; need anesthesia

Question 12

Cervical Intraepithelial Neoplasia (CIN) TX

Answer 12

LEEP/LEETZ (loop electrical excision proc); 6-10 mm; tissue pathology

Question 13

CIN I/II/III

Answer 13

Cervical Intraepithelial Neoplasia
I: Mild Dysplasia
II: Moderate Dysplasia
III: Severe Dysplasia/Carcinoma In Situ (CIS)

Question 14

Cervical Intraepithelial Neoplasia (CIN) Severe CIN III TS

Answer 14

Conization, cold-knife cone/surgical blade

LEEP

Question 15

Pap Smear post treatment

Answer 15

Repeat pap or HPV at 6 and 12 months
HGSIL: Repeat cytology and coposcopy at 6 month intervals for 24 months. IF worsens –> LEEP IF 2 neg pap/cop –> return to normal screening

Question 16

HPV types

Answer 16

High Risk - 16, 18

Low Risk - 6,11

Question 17

HPV Testing

Answer 17

Hybrid Capture 2 (HC2): ELISA, tests for many strains.

Cervista: Only tests 16, 18

Question 18

HPV Immunization

Answer 18

Males and Females age 9-26. Contraindicated in pregnancy.
Cervarix: 16 and 18. 3 doses: 0,1,6 mo.
Gardasil: 6,11, 16,18. 3 doses: 0,2,6 mo.

Question 19

Cervical Cancer Stats

Answer 19

2nd most common cancer in women
Screening and Vaccinations are decreasing this.
Two Types:
1. Squamous Cell Carcinoma (80-90%)
2. Glandular / Adenocarcinoma (10-20%)
Median age of diagnosis: 47 years
Hispanics are diagnosed. Whites die of it.

Question 20

Factors contributing to cervical cancer

Answer 20

Never or rarely been screened
false negative cytology tests
Cytology test abnormal, patient lost to follow-up
Cytology test abnormal, patient mismanaged
Rapidly progressive
Uncommon cancers difficult to detect