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GYN > Cervical dysplasia > Flashcards

Cervical dysplasia Flashcards

1
Q

most cervical cancers are caused by

A

99.7% of cervical ca due to HPV infection

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2
Q

prognosis of cervical cancer and cell type

A

70% are squamous cell carcinoma (tend to be superficial, spread slowly, don’t tend to metastasize)

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3
Q

what % are adenocarcinoma

A

), 10-25% are adenocarcinoma (tend to behave more aggressively; in younger women; M&M related to this type)

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4
Q

mean age of cervical cancer diagnosis

A

Mean age at diagnosis 48 yrs

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5
Q

Risk Factors for cervical cancer

A

increased risks for HPV infection•

Early sexual activity
• High lifetime number of sexual partners
• Infection with HIV
• Smoking
• Long-term use of oral contraceptives (>5 years)
• Low socio-economic status

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6
Q

Protective Factors for cervical cancer

A
  • Use of barrier contraception and spermicides

* High levels of vitamin C to boost your immune system to clear the infection

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7
Q

Screening Tools for cervical cancer

A

i. Pap smear
ii. HPV testing
iii. Colposcopy  diagnostic tool for when someone has a positive screening test

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8
Q

cervical cancer screening recommendations

A

recommends screening for cervical cancer in women ages 21 to 65 years with cytology (Pap smear) every 3 years

OR

for women ages 30 to 65 years who want to lengthen the screening interval, screening with a combination of cytology and human papillomavirus (HPV) testing every 5 years.

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9
Q

the difference in cervical screening recommendations

A

for women over 30 there is a disagreement with co-testing

ACC and ACOG recommend preferred testing as co screening and the alternative is cytology every s yrs

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10
Q

PAP smear screens for

A

squamous cell carcinoma not as well as adenocarcinoma

w/ irregular bleeding or abnormal looking cervix you do need to go further

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11
Q

tools for pap

A

Cytobroom is all-in-one sampling tool

spatula can be used with cytobrush

i. Not a sterile exam
ii. Gown & drape patient
iii. Gloves
iv. Speculum
v. Cytobrush & collection kit
vi. Warm water or lubricant*

need to get cells from the squamocellurlar junction

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12
Q

things that may effect the pap

A

semen in the last 72 hours
use a Q tip to clean off the cervix first

sometimes if the pt recently had intercourse their cervix can be inflammed

not sex recently no period in the last 4 days ideally

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13
Q

results of pap

A

insufficient evidence
normal epithelial
low risk or high risk lesion

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14
Q

Most abnormal Pap results are

A

low-grade lesions in young women (<30 yrs), due to HPV infection

Majority of lesions regress spontaneously within 8-24 months
especially if patient is on vitamin C)

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15
Q

if PAP smears are abnormal

A

If abnormal Pap results (cytology) you want to know HPV status as a diagnostic tool

so either you order a reflex meaning if a pap is abnormal you get HPV test

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16
Q

Low-Risk Group (most common)

A

ASC-US
Atypical Squamous Cells of
Undetermined Significance

this can progress to–>

LSIL (higher grade lesion than ASC-US)
Low-grade Squamous Intraepithelial
Lesion (precancerous cells)

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17
Q

mngmt of LSIL

A

colposcopy

these cells are definitely dysplastic and have probably been around for a while

continued abnormality

18
Q

High-Risk Group mngmt

A

requires colposcopy and biopsy

you need to know that this is anything outside of LSIL or ASC-US

19
Q

ASC-US mngmt 21-24

A

repeat PAP in 12 mo

20
Q

ASC-US mngmt >25

A

reflex testing

if NEG–> repeat PAP in 3 yrs
HPV positive –> colposcopy

21
Q

LSIL and ASC-US in post menopausal women

A

often due to estrogen loss
low rate of HPV infection in this population

premarin 1gm in vagina qhs x3WKS then repeat 1 week after treatment

(1 month later)

22
Q

HPV most oncogenic

A

16 and 18

23
Q

low risk HPV

A

6 and 11 are low risk most commonly associated with gential warts

24
Q

do not do HPV testing in

A

HIV positive or chemo

25
Q

Cytology negative, HPV negative

A

Routine screening at 3-5 years

26
Q

Cytology ASC-US, HPV negative

A

Repeat cytology 3 years for most patients

most likely due to recent intercourse or estrogen loss

27
Q

Cytology ASC-US, HPV positive

A

Colposcopy

28
Q

Cytology negative, HPV positive

A

Repeat both tests in 12 months*

29
Q

Cytology negative, HPV positive F/U

A

in 12 mo if both negative–> routine screening

if positive cytology and neg HPV–> cleared infection with some atypical cells

if at the follow up cytology is high grade regardless of HPV–> colposcopy

30
Q

colposcopy

A

acidic acid vinegar solution that will highlight dysplasia

–> help with identifying biopsy areas

31
Q

SCJ:

A

The current junction where the squamous and columnar cells meet on the surface of the cervix at the time the patient is being evaluated; it demarcates the junction of the endocervical glandular epithelium and the squamous epithelium after squamous metaplasia is completed.

in women that take birth control early this can be more external

32
Q

Presenting symptoms of cervical cancers

A

usually asymptomatic

Presenting symptoms may include
bleeding between periods of after intercourse

33
Q

Tx for cervical cancer

A

Can have cone biopsy

can have hysterectomy with or w/wo radiation `

34
Q

how would you ID a ectropion form a lesion

A

normal PAP

would see less white on colposcopy

35
Q

cervicitis looks like

A

Red beefy sadness with discharge

36
Q

atrophic vaginitis is seen

A

5 years after menopause can be relieved with estrogen

37
Q

cervical lacerations occur

A

with childbirth if pushing too early

38
Q

Case 1 - Pap smear screening

32 yo G2P1 (SAB1) woman presents for a pelvic exam and Pap smear. She had ASC-US and HPV negative 4 yrs ago, her f/up smear 6 mos later was WNL. Her son is 3 yrs old, she had a miscarriage 8 mos ago

What other history questions should you ask?.

A

LMP, sexual hx, contraception, hx of STIs, does she want to get pregnant again, any cervical procedures, any pelvic pain, dyspareunia

39
Q

ASC-US means

A

atypical cells of undetermined significance

these just look a little different

40
Q

41 yo WWE
pap with reflex testing
married been with husband for a whole
cytology ASCUS and negative for HPV

A

she doesn’t need another pap for 12 months?

but can be

41
Q

24yro
pap and GC Chlamydia and need for refill
ASCIS positive

A

neg
ASCIS

recheck in a year and do reflex testing then

42
Q

52 yo woman yearly physical

A

lipids
colo
HPV co testing can go to five years

GYN (13 decks)

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