Cervical neoplasia Flashcards
Most cases of cervical cancer are in?
1 cancer killer of women in developing world
CIN I II III?
I is 1/3, II is 2/3, III is more than 2/3 INCLUDING full epithelial thickness
Screening guidelines for 21-29 year olds?
Pap every 3 years
Screening guidelines for 30 and older?
Pap test and HPV test.
If NEGATIVE, re-screen no sooner than every 5 years
If HPV testing isn’t available, screen with pap every 3 years.
When can cervical cancer screening stop?
Over age 65
Hysterectomy for benign reasons and no history of CIN 2 or higher.
HPV’s effect on a cell?
Nuclear enlargement, perinuclear cytoplasmic clearing, multinucleation, hyperchromasia (resolve when infection resolves)
Atypical squamous cells. Which categories go directly to colpo?
LSIL, HSIL, ASC-H (atypical squamous cell cannot exclude high-grade squamous intraepithelial lesion)
No HPV typing because almost everyone with these is positive.
What do you do with ASC-US?
HPV DNA testing aka. reflex HPV testing
ASC-US high-risk HPV negative?
Continue routine pap screening
ASC-US high-risk HPV positive?
Colpo and cervical biopsies if indicated
Patient >30 years old, normal pap but POSITIVE high-risk HPV?
Repeat pap and HPV screen in 12 months.
If abnormal, colpo.
If HPV TYPING is available, do that. If negative for the HIGH RISK STRAINS don’t need colpo.
Changes on colposcopy that warrant biopsy?
Acetowhite epithelium, mosaicism, punctations, atypical vessels
Options for CIN I lesions?
Repeat pap (cytology) 6 months x 2
OR
Repeat HPV testing in 1 year
If either pap is abnormal OR if the high-risk HPV is positive, REPEAT COLPO AND BIOPSY.
LEEP if persistent for 2 years
Options for CIN II and III lesions?
Surgical excision via LEEP (formerly was cold-knife conization)
Infrequent complications of LEEP or CKC?
Cervical stenosis, cervical insufficiency, infection, bleeding
