Cervical Neoplasia / Cancer Flashcards
Pap smears -when to start
Start at age 21 regardless of sexual hx (ACOG 2009)
If ascus and under 20 (who knows why they got a pap)….
Repeat in 12 mo
Women from ages 21 to 30 be screened….
every three years using either the standard Pap or liquid-based cytology.
Women age 30 and older who have had three consecutive negative cervical cytology test results may be screened…
Once every three years with either the Pap or liquid-based cytology
Once every five years with co-testing
Women with certain risk factors may need more frequent screening, including those who have….
HIV, areimmunosuppressed, were exposed to diethylstilbestrol (DES) in utero, and have been treated for cervicalintraepithelial neoplasia (CIN) 2, CIN 3, or cervical cancer.
If total hysterectomy for benign condition, does the patient still need PAPs?
NO
If supracervical hysterectomy & still have cervix, does the patient still need PAPs?
Yes, regular screening
Should a pap be deferred if bleeding is present?
Yes, defer Pap smear if bleeding present (messes up results)
Pap result: Atypical squamous cells (ASC)
Many have severe dysplasia
If ASC-US… what are the next steps in w/u?
Reflex HPV testing.
If positive, then colpo.
If not then repeat Pap in 1 year
If ASC-H or LSIL / HSIL or atypical glandular cells… what are the next steps in w/u?
Get colpo! Don’t bother with HPV.
Worrisome colpo results
Acetowhite changes, mosaicism, punctations, atypical vessels → biopsy these!
Path results: CIN I
Repeat cytology q6mo x 2 or repeat HPV testing in 1 year
Path results: CIN II / III
Treat with surgical excision (LEEP > cold knife cone)
After colpo, need to do a cone / Leep excision if….
AdenoCa in situ, positive endocervical curretage (LSIL,HSIL, etc), unsatisfactory colpo (can’t visualize entire transition zone, etc), or big discrepancy between Pap & bx results (e.g. HSIL on Pap, then normal colpo → need excision!)
