Cervix 1 Flashcards
Cystic structure that forms when columnar epithelium is covered by squamous epithelium
Glandular material becomes retained
What is this?
Nabothian cysts
Appear as translucent or yellow
Range in size from millimeters to 3cm
Benign
Asymptomatic – seen during speculum exam
Clinical px of what?
Nabothian cysts
is excision required for nabothian cysts?
NO
Etiology is unknown but may be due to chronic inflammation of cervical canal
what dz?
cervical polyps
Usually < 3cm
Benign
May cause post-coital bleeding or abnormal uterine bleeding
What dz?
cervical polyps
tx for symptomatic cervical polyps pts
polypectomy
what kind of tissue is he ectocervix made of?
stratified squamous epithelium
what type of tissue is the transformation zone made of?
Squamo-columnar junction
Metaplastic squamous epithelium
what kind of tissue is the endocervical canal made of?
single layer of mucin-producing columnal cells
describe adequate sampling of cervix
requires presence of endocervical sampling
how does HPV enter the body?
The virus enters the cervical epithelium through microlacerations that occur during intercourse.
HPV Pathophys:
The ___________ is very susceptible to the virus vs. squamous tissue.
The TZ/metaplastic tissue is very susceptible to the virus vs. squamous tissue.
what layer does HPV affect first?
infects basal layer first and only locally infects neighboring cells
can the HPY virus remain latent?
YES; The virus can remain latent for months to years until the host immune system no longer can successfully suppress the virus or poorly understood co-factors are present.
Mature___________ cellscontaining viral HPV migrate away from the basement membrane toward the surface.
Mature basal epithelial cells containing viral HPV migrate away from the basement membrane toward the surface.
what are the 2 main HPVs that are responsible for progressing to cervical cancer?
16 & 18
MC type of CA associated with HPV 16
squamous cell carcinoma
MC type of CA associated with HPV 18
Adenocarcinoma
low risk types of HPV cancer
6 & 11
RF for HPV infection
_*Multiple sexual partners*_
Smoking: Carcinogens found in cervical mucus
Immunosuppression
Early onset of sexual activity
History of STIs
Hx VIN or VAIN
Long-term oral contraceptive use
how can you prevent HPV?
Gardasil 9 vaccine: protects against types 6, 11, 16, 18, 31, 33, 45, 52, 58
Dosage schedule of HPV vaccines
< 15 y/o, 2 doses at 0 and 6-12 months
≥ 15 y/o, 3 doses at 0, 1-2, and 6 months
do pap smears or HPV DNA testing have higher sensitivity/specificity?
HPV DNA testing
do pts who have received vaccination require ongoing cervical screening based on age appropriate guidelines?
yes
screening is for what type of pts?
asx or pts with risk factors
when is HPV screening initiated?
Screen women starting at the age of 21 despite the age of sexual debut
does screening prior to the age of 21 reduce their rate of cervical CA?
NO
HPV:
T/F: Nearly all cases are cleared within 1-2 yrs without producing neoplastic change.
True
what can early onset screening cause
increases anxiety & morbidity
accrue higher expenses
overuse of follow-up procedures
Adolescent pt encounters should include what 5 things?
Contraceptive Counseling
STI screening: Urine sample
HPV vaccination education/administration
Safe sex practices
No Pap smear unless in high-risk population
**Speculum exam is not required in asx women**
screening for cervical CA in women 21-29 y/o
Cytology performance alone q 3 years
Do not perform HPV DNA testing
screening for cervical CA in women 30-64 y/o
Cytology/HPV DNA co-testing q 5 years
OR
Cytology alone q 3 years
Cervical CA screening for HIV + women
Begin screening at the age of diagnosis
Screened q 6 mos the year of diagnosis then q year
What 5 populations are at high-risk for developing cervical CA and who need yearly screening?
HIV positive women
Immunocompromised
Personal history of cervical cancer
History of CIN II/III
Exposure to diethylstilbestrol (DES)in utero
You can stop cervical CA screening for non-risk women at age 65 if in the past 10 years….
Patient has evidence of 3 prior consecutive negative results with cytology alone
OR
2 consecutive negative Co-testing results
**The most recent test has to have occurred within 5 years
**Cannot have a history of CIN 2+ within last 20 years
should you resume screening if a woman reports a new sexual partner?
NO
When does screening stop in women after hysterectomy (cervix is removed)?
Stops at the time of surgery
If Hysterectomy performed for benign disease
If No history of CIN 2 + within 20 years
What additional procedure should you perform in the following?
WHEN PERFORMING SPECULUM EXAMINATION AND AN ABNOMRAL CERVICAL LESION IS NOTED
biopsy. NOT papsmear
pap smear vs biopsy
pap smear = screening tool
bipsy = diagnostic
