Cervix 2 Flashcards
screening procedure if ASC-US is found in women ages 21-24
ASC-US (atypical cells of undetermined significance)
repeat cytology in 1 year
screening procedure if ASC-US in women 25 or older
Must reflex to HPV DNA
Negative HPV DNA = NORMAL cytology
Repeat co-testing in 3 years
Positive HPV DNA = colposcopy
Causes of ASCUS cytology in the absence of HPV include what?
Chlamydia trachomatis
Herpes simplex
Vulvovaginal atrophy
screening if on dx:
LSIL: low grade squamous intraepithelial lesion
Age 21 – 24
Preferred to repeat cytology in 1 year
screening if on dx:
LSIL: low grade squamous intraepithelial lesion
Age 25+
Refer for colposcopy despite HPV result
OR
Repeat co-testing in 1 year if HPV DNA testing is negative
Lesions usually consistent with CIN I
screening if on dx:
HSIL/ASC-H: High grade
Assume HPV DNA is present
Refer for colposcopy despite HPV result (all ages)
Negative HPV HSIL carries a 5 year risk for CIN 3+ of 29%
Lesions usually consistent with CIN II-III, AIS
what screening should follow if on dx:
Negative cytology, no endocervical cells
for women 21 – 29
Routine screening – repeat Pap in 3 years
DO NOT perform HPV DNA testing
what screening should follow if on dx:
Negative cytology, no endocervical cells
for women Age ≥ 30
Perform HPV DNA testing
If Negative: Repeat Pap in 5 year
If Positive: Refer for colposcopy if HPV 16/18
OR
Repeat cytology and HPV in 12 months
What can cause an unsatisfactory cytology?
Due to insufficient squamous component
HPV test may be falsely negative due to insufficient sampling
If you get an unsatisfactory cytology and there was No HPV testing done, what screening should follow?
Repeat Pap in 2 – 4 months (any age)
Do NOT add on HPV test if not initially ordered
If you get an unsatisfactory cytology and there was HPV testing performed for women age > 30, what screening should follow?
Negative HPV: Repeat Pap in 2 – 4 months
Positive HPV: Refer for colposcopy
Screening for women 30+ years with negative cytology but positive high risk HPV DNA
Colposcopy if genotype is (+) for HPV 16/18
Repeat co-testing in 12 months for non- HPV 16/18
follow up screening if combined screening of HPV DNA and cytology is negative in 12 months
repeat co-testing in 3 yrs
follow up screening if combined screening of HPV DNA and cytology is positive in 12 months
refer for colposcopy
why do we perform a combined screening?
Important to differentiate between transient and persistent HPV infection.
Persistently positive HPV DNA test (x2) is associated with a 21% chance CINII/III will be present within 36 months*
CIN I: Lesions typically regress in what amount of time?
12 mos
CIN I involves what part of epithelial lining?
lower third
CIN II involves what part of epithelial lining?
lower 2/3rds
CIN III involves what part of epithelial lining?
more than 2/3rds of epithelial lining
satisfactory colposcopy
Complete visualization of transformation zone
Unsatisfactory colposcopy
what additional procedure do you have to perform?
Incomplete visualization of transformation zone
Have to perform endocervical curettage (ECC)
Magnified view of cervix after application of 5% acetic acid
what procedure is this?
colposcopy
mgmt for women 21-24 y/o who test positive for ASCUS or LSIL
Cytology ALONE in 12 months
If Persistent ASCUS/LSIL at 24 months: Colposcopy
mgmt for women 21-24y/o who test positive for ASC-H/HSIL
colposcopy
mgmt for women >24 who test positive for ASCUS but negative for HPV
co-testing @ 3 yrs
mgmt for women >24 who test positive for LSIL/CIN 1, negatie HPV
Co-testing at 12 months
If Negative: Co-test in 3 years
Abnormal: Colposcopy
mgmt for women >24 y/ol with persistent CIN for 24 months
LEEP Vs Continued follow-up
mgmt for women 21-24 y/o who test positive for HSIL/ASC-H
colposcopy
do not triage to LEEP!!**
mgmt for women 21-24 y/o who test positive for HSIL/CIN I or less
Cytology and colposcopy q 6 months up to 24 months
LEEP indications
Persistent HSIL (24 mos)
CIN 2+
Unsatisfactory colposcopy
mgmt for women 25+ who test positive for HSIL/ASC-H
colposcopy or LEEP
mgmt for women 25+ who test positive for HSIL/ASC-H & completed a colposcopy & are HSIL/CIN 1 or less
LEEP
or
Co-testing at 12 and 24 months
If Negative: Re-test at age appropriate interval
If HPV positive and cytology < HSIL: Colposcopy
If HSIL at 12 or 24 months: LEEP
mgmt for women 25+ who test positive for HSIL/ASC-H & completed a colposcopy & are HSIL/CIN 2+
LEEP
High electrical current density results in rapid heating of the nearby tissue.
A steam envelope surrounding the wire is created which vaporizes adjacent tissue.
Tissue sent for pathology
What procedure is this
Loop Electrosurgical excision procedure
Ci of LEEP
if invasion is suspected
glandular abnormality on PAP
pregnancy
what has replaced laser surgery for tx of CIN?
LEEP
LEEP post-procedure instructions/education
Avoid heavy lifting for 4 weeks to avoid bleeding
Malodorous vaginal discharge for 2-3 weeks
Avoid intercourse for 4 weeks
Avoid douches, creams and tampons within the vagina for 4 weeks
First menses after LEEP is heavier due to partial removal of endocervical canal
F/U post LEEP:
Repeat co- testing at 12 and 24 months
If Both negative: re-test in 3 years
If Abnormal: repeat colposcopy with ECC
** age appropriate screening for at least 20 years even if > 65**
If + margins after LEEP
Repeat cytology and ECC at 4 – 6 months
If persistent CIN 2+ following LEEP
Repeat LEEP
Hysterectomy
avg age of dx for cervical CA
35-44 y/o
HPV type 16 and 18 associated in 70% of cases
Prevalence is 65-85% and ↓falling
Microinvasion (< 3 mm)
Invasive (> 3mm or visible lesion)
what type of cervical CA?
Cervical squamous cell CA
HPV type 16 and 18 associated in 86% of cases
Prevalence is 1-25% and ↑rising
Types: Endocervical, Endometrioid, Clear Cell, Adenoid Cystic
what type of cervical CA?
cervical adenocarcinoma
Frequently ASYMPTOMATIC
_MC sx: Abnormal vaginal bleeding**_
Postcoital bleeding
Unilateral pelvic pain with radiation into the hip or thigh
Sign of advanced disease
Vaginal discharge: Watery, mucoid, purulent, malodorous
Clinical px of what?
cervical CA
