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Foundations III-Women's Health > disorders of the cervix > Flashcards

disorders of the cervix Flashcards

1
Q

what is a nabothian cyst?

A

Cystic structure that forms when columnar epithelium is covered by squamous epithelium

translucent/yellow

benign, asx., no excision required

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2
Q

characteristics of cervical polyps

A

may be d/t chronic inflammation of cervical canal

benign, usu. < 3cm

Polypectomy for symptomatic patients

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3
Q

what cells make up the 3 parts of the cervix?

A

Ectocervix = Stratified squamous epithelium

*Transformation zone =
Squamo-columnar junction and metaplastic squamous epithelium

Endocervical canal =
Single layer mucin-producing columnar cells (sample needs endocervical cells)

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4
Q

HPV pathophys

A

enters through microlacerations during intercourse

Transition zone/metaplastic tissue very susceptible to virus vs. squamous tissue

infects basal layer 1st

can be latent mo’s to yr’s

migrates away from BM toward the surface

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5
Q

Squamous cell carcinoma and adenocarcinoma assoc. w/ which type of HPV?

A

SCC = HPV 16

adeno = HPV 18

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6
Q

what are low risk types of HPV

A

6 and 11

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7
Q

Who typically has highest rates of HPV

A

women, adolescents/young adults 15-24y/o

75-80% sex active will acquire before age 50

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8
Q

RF’s for HPV infx

A
  • Multiple sexual partners

Smoking, immunosuppression, early onset sex activity, h/o STI’s, long-term OCP use, Hx VIN and VAIN

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9
Q

Performing a pap smear

A

go into T. zone including endocervical canal and rotate 180 degrees.

Pap smears and HPV DNA testing

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10
Q

Patients who have received HPV vaccination require…

A

ongoing Pap smears based on age appropriate guidelines

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11
Q

primary screening tool for cervical CA?

A

PAP alone vs. co-testing vs. HPV

25-29 PAP q 3 yrs

never HPV testing until 25…ever!!

start at age 21y/o til 65

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12
Q

when is screening for cervical cancer initiated?

A

the age of 21 despite the age of sexual debut

screening does NOT reduce rate of cerv. CA prior to 21

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13
Q

nearly all cases of HPV are cleared w/in…

A

1-2 yrs w/out producing neoplastic change

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14
Q

Adolescent patient encounters should include:

A 
Contraceptive Counseling
STI screening
HPV vaccination education/administration
safe sex practices
No Pap smear unless in high-risk population
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15
Q

screening for cervical CA women aged 21-29

A

Cytology performance alone q 3 years

Do not perform HPV DNA testing

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16
Q

screening for cervical CA women aged 30-64

A

Cytology (+) HPV DNA testing q 5 years or

Cytology alone q 3 years

17
Q

screening for cervical CA in pt’s at high risk who need yrly screening

A 
HIV positive women (6mo, 12mo, then yrly)
Immunocompromised
Personal h/o cervical cancer
h/o CIN II/III
exposure to DES in utero
18
Q

when does screening for Cerv. CA stop?

A

65y/o…
so long as they are up to date (3 neg cytology in past 10yrs OR 2 neg co-tests w/most recent w/in 5 yrs) AND not high risk

hysterectomy (cervix removed)

19
Q

When Performing speculum exam & an abn. cervical lesion is noted, perform…

A

BIOPSY NOT PAP SMEAR.

20
Q

ASC-US (atypical cells of undetermined significance) result, plan?

A

Age 21 – 24: preferred to repeat cytology in 1 year

Age 25+:
Must reflex to HPV DNA
- Neg HPV DNA = norm (repeat x3yrs)
- Pos HPV DNA = colposcopy

in absence of HPV: chlamydia trachomatis, Herpes simplex, vulvovaginal atrophy

21
Q

LSIL: low grade squamous intraepithelial lesion result, plan?

A

Age 21 – 24: preferred to repeat cytology in 1 year

Age 25+:

  • Refer for colposcopy despite HPV result OR
  • Repeat co-testing in 1 yr if HPV DNA testing is neg
  • Lesions usu. consistent w/CIN I
22
Q

HSIL/ASC-H: High grade result, plan?

A

Assume HPV DNA is present (no testing)

Refer for colposcopy

lesions usu. consistent w/ CIN II-III, AIS (adenocarcinoma insitu)

23
Q

neg. cytology, no endocervical cells result, plan?

A

Age 21 – 29: repeat Pap in 3 years
DO NOT perform HPV DNA testing

Age ≥ 30:
Perform HPV DNA testing
- if pos. –> colposcopy or repeat cytology and HPV in 12 mo’s
- if neg –> repeat pap 5yrs

24
Q

unsatisfactory cytology results, plan?

A

d/t insufficient squamous component

HPV may be falsely neg.

NO HPV testing: repeat pap in 2-4 mo’s (do not add HPV if not initially ordered)

HPV testing performed age > 30

  • neg –> Repeat Pap in 2-4 mo’s
  • pos –> refer for colposcopy
25
Q

combined screening

A

Women 30+ years with neg cytology but pos. high risk HPV DNA:

  • Colposcopy if genotype is (+) for HPV 16/18
  • Repeat co-testing in 12 months for non- HPV 16/18

if neg in 12mo’s repeat co-testing in 3 yrs

if pos in 12mo’s refer for colposcopy

differentiate btwn transient and persistent HPV infection

Persistently positive HPV DNA test (x2) assoc. w/CIN II/III

26
Q

if colposcopy is unsatisfactory?

A

incomplete visualization of transformation zone then have to perform ECC (endocervical curettage)

27
Q

Colposcopy: bx acetowhite epithelium?

A

Leukoplakia, ulcerations, punctation, mosaicism, atypical vessels

28
Q

management of ASCUS/LSIL age 21-24

A

Cytology ALONE in 12 months

Persistent ASCUS/LSIL at 24 months –> colposcopy

ASC-H/HSIL –> Colposcopy

29
Q

management of ASCUS/LSIL Age > 24

A

ASCUS or LSIL/CIN 1, negative HPV:
Co-testing at 12 months
- Neg–> Co-test in 3 yrs
- abn. –> Colposcopy

30
Q

management of ASCUS/LSIL w/persistent CIN 1 for 24 months

A

LEEP Vs Continued follow-up

31
Q

management of HSIL/ASC-H age 21-24

A

Immediate triage to LEEP is unacceptable
Colposcopy
HSIL/CIN I or less –> cytology and colposcopy q 6 months up to 24 mo’s

LEEP is indicated for the following:

  • Persistent HSIL (24 mos)
  • CIN 2+
  • Unsatisfactory colposcopy
32
Q

management of HSIL/ASC-H age 25+

A

Colposcopy or LEEP

If colposcopy done and HSIL/CIN 1 or less:
LEEP OR co-test at 12 and 24mo’s
- neg. retest at approp. age level
- HPV pos & cytology < HSIL –> colopscopy
- HSIL at 12-24 mo’s = LEEP

If colposcopy done and HSIL/CIN 2+
LEEP is indicated

33
Q

LEEP procedure

A

High electrical current heats up and vaporizes nearby tissue that is sent for path

CI w/ susp. invasion, glandular abn on PAP or pregnant

90-95% cure rate

34
Q

LEEP f/u pt education

A

Avoid heavy lifting, intercourse, douches, creams, tampons for 4 weeks

First menses after LEEP is heavier due to partial removal of endocervical canal

Malodorous vaginal discharge for 2-3 weeks

35
Q

LEEP morbidity

A

Bleeding
Infection
Cervical obliteration, incompetence, stenosis
assoc. w/pre-term delivery, after PPROM

36
Q

LEEP f/u

A

Repeat co- testing at 12 and 24 months:

  • both neg > retest 3 yrs
  • abn. > repeat colposcopy w/ECC
  • continue age approp. screening at least 20yrs

(+) margins after LEEP: repeat cytology and ECC at 4-6mo’s

persistent CIN 2+ following LEEP: repeat LEEP, hysterectomy

37
Q

cervical CA etiology

A

Cervical squamous cell cancer: HPV 16 & 18, prevalence 65-85%, microinvasion (< 3mm), invasive (>3mm)

Cervical adenocarcinoma: HPV 16 & 18, prevalence 1-25%, type endocervical, endometrioid, clear cell, adenoid cystic

38
Q

clinical presentation for cerv. CA

A

Frequently ASYMPTOMATIC

MC = Abnormal vaginal bleeding

Postcoital bleeding

vaginal dc

Unilateral pelvic pain with radiation into the hip or thigh

Foundations III-Women's Health (13 decks)

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