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Foundations 3 > Disorders of the Cervix > Flashcards

Disorders of the Cervix Flashcards

1
Q

What are Nabathian Cysts

A

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

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2
Q

How do Nabothian Cysts appear?

A

Appear as translucent or yellow

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3
Q

How do Nabothian Cysts present?

A

Asymptomatic and benign. Only seen during speculum exam

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4
Q

Do Nabothian Cysts require excision?

A

No

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5
Q

What is the etiology behind developing Cervical polyps?

A

Etiology is unknown but may be due to chronic inflammation of cervical canal

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6
Q

What is the size for Cervical polyps?

A

Usually <3cm

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7
Q

What is a complication of cervical polyps?

A

May cause post-coital bleeding or abnormal uterine bleeding

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8
Q

Treatment for Cervical polyps?

A

Polypectomy

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9
Q

What are the Histologic layers Cervical Intraepithelial Neoplasia?

A

Ectocervix
Tranformation zone
Endocervical canal

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10
Q

What is the in the Ectocervix

A

slide 8

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11
Q

Transformation zone?

A

slide 8

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12
Q

Endocervical canal

A

slide 8

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13
Q

Which viruse is responsibile for Cervical Intraepithelial Neoplasia?

A

HPV 16

HPV18

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14
Q

Which type of cervical cancer is HPV 16 responsible for?

A

Squamous Cell Carcinomas 50-60%

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15
Q

Which type of cervical cancer is HPV 18 responsible for?

A

Adenocarcinomas 40-60%

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16
Q

Risk factors for HPV Infection?

A 
Multiple sexual partners***
Smoking
Carcinogens found in cervical mucus
Immunosuppression
Early onset of sexual activity
Hx of VIN and Vain
History of STD’s
Long-term oral contraceptive use
      \+/- Estrogen receptors in HPV gene
Multiparity
     Maintenance of transformation zone
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17
Q

Which HPV types can block the protective apoptotic process?

A

HPV E6 and E7

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18
Q

What vaccine used for HPV?

What must be done after receiving the vaccine?

A

Gardasil 9

Require ongoing Pap smears based on age appropriate guidelines

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19
Q

What is another screening tool used besides a PAP smear for HPV

A

HPV DNA testing

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20
Q

What age is recommended to start PAP smears?

A

Start 21 despite the age of sexual debut

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21
Q

What age can you start to consider HPV/Cervical Cancer screenings?

A

No later than 25

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22
Q

Do screenings prior to age 21 reduce rate of cervical cancer?

A

NO

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23
Q

What population do these recommendations for Cervical Cancer not apply to?

A

High risk populations (immunocompromised)

Should be screened earlier

24
Q

When screening adolescents for HPV what kind of precautions or educations should be done?

A

Contraceptive Counseling
STI screening
Urine sample
Speculum exam not required in asymptomatic women
HPV vaccination education/administration
Safe sex practices
No Pap smear unless in high-risk population

25
Q

What are screening guidelines are recommended for 21-29?

A

Cytology performance alone q 3 years

Do not perform HPV DNA testing

26
Q

What are screening guidelines recommended for 30-64 yr women?

A

Cytology (+) HPV DNA testing q 5 years or

Cytology alone q 3 years

27
Q

Which type of patients would need yearly cervical cancer screenings?

A

High risk patients

  1. HIV positive women
    • Screened q 6 mos the year of diagnosis then q year
    • Begin screening at the age of diagnosis
  2. Immunocompromised
  3. Personal history of cervical cancer
  4. History of CIN II/III
  5. Exposure to Deithystilbestrol in utero (given to women to suppress preg. complications)
28
Q

When do you stop screening for Cervical cancers?

A

Stop at the age of 65 if in the past 10 years….

  1. Patient has evidence of 3 prior consecutive negative results with cytology alone OR
  2. Two consecutive negative Co-testing results
  3. The most recent test has to have occurred within 5 years
  4. Can not have a history of CIN 2+ within last 20 years
29
Q

When does cervical screening stop in women after hysterectomy (cervix is removed)?

A
  • Stops at the time of surgery
  • Hysterectomy performed for benign disease
  • No history of CIN 2 + within 20 years
30
Q

What must you do while performing speculum examination and an abnormal cervical lesion?

A

Perform BIOPSY

NOT Pap Smears

  • A Pap smear is a screening tool whereas biopsy is diagnostic
31
Q

While performing cytology tests, what is recommended to do if we find ASC-US in 21-24 year olds?

A

Preferred to repeat cytology in 1 year

32
Q

Recommendations for ASC-US in Age 25 and up

A

Must reflex to HPV DNA

Negative HPV DNA = NORMAL cytology
So repeat co-testing in 3 years

Postive HPV DNA = colopscopy

33
Q

What is the cause of ASCUS cytology in the absence of HPV?

A

Chlamydia trachomatis, Herpes simplex

Vulvovaginal atrophy

34
Q

Recommendations for LSIL types found in 21-24 y/o?

A

Same as ASCUS

35
Q

Recommendations for LSIL in 25+

A

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

36
Q

If you find HSIL/ASC-H (High grade) types what can we safely assume is present?

A

HPV DNA

37
Q

Recommendations for HSIL/ASC-H (High grade) cells?

A

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

38
Q

What are recommendations for Negative cytology samples with no endocervical cells: 21-29?

A

Routine screening – repeat Pap in 3 years

DO NOT perform HPV DNA testing

39
Q

What are recommendations for Negative cytology samples with no endocervical cells: 30 and above

A

Perform HPV DNA testing
-Negative: Repeat Pap in 5 years
-Positive:
-Refer for colposcopy if HPV 16/18
OR
-Repeat cytology and HPV in 12 months

40
Q

What causes an Unsatisfactory cytology test?

A

Insufficient sampling, so HPV test can be FALSELY neg.

41
Q

Recommendations for Unsatisfactory cytology?

A

No HPV testing

  • Repeat Pap in 2 – 4 months (any age)
  • Do NOT add on HPV test if not initially ordered

HPV testing performed at age 30 and up

  • Negative: Repeat Pap in 2 – 4 months
  • Positive: Refer for colposcopy
42
Q

Women 30+ years with negative cytology but positive high risk HPV DNA should get what screenings?

A

Colposcopy if genotype is (+) for HPV 16/18

Repeat co-testing in 12 months for non-HPV 16/18

If negative in 12 months repeat co-testing in 3 years

If positive in 12 months refer for colposcopy

43
Q

What do the grades od Cervical Intrepithelial Neoplasia indicate?

A

Grades I,II,III get worse as you go down

44
Q

Screenings for ASCUS or LSIL ages 21-24?

A

Cytology ALONE in 12 months

45
Q

Management of Persistent ASCUS/LSIL at 24 months for Ages 21-24

A

Colposcopy

46
Q

Management for ASC-H/HSIL (high grade) at ages 21-24 years

A

Colposcopy

47
Q

Management of ASCUS/LSIL in Ages 24 or older?

What if is a Persistent CIN 1 for 24 months?

A

ASCUS or LSIL/CIN 1, negative HPV:
Co-testing at 12 months
-Negative: Co-test in 3 years
-Abnormal: Colposcopy

LEEP Vs Continued follow-up

48
Q

Managment for HSIL/ASC-H (high grade) in ages 21-24?

A

Immediate triage to LEEP is unacceptable
Colposcopy

HSIL/CIN I or less
     -Cytology and colposcopy q 6 months up to 24 months
LEEP is indicated for the following:
     -Persistent HSIL (24 mos)
     -CIN 2+
     -Unsatisfactory colposcopy
49
Q

Management of HSIL/ASC-H in Ages 25 and up?

A

Colposcopy or LEEP

50
Q

What is LEEP?

A

Loop Electrosurgical Excision Procedure

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

90-95% cure rate that has replaced laser surgery for treatment of CIN

51
Q

LEEP Follow Up recomendations

A
  • 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
52
Q

What are complications after performing a LEEP?

A 
Bleeding 
Infection
Cervical oblieration/incompetence
Associated with pre-term delivery***
Asociated with pre-term delivery after PPROM
53
Q

What are LEEP followup screenings recommendations?

A

Repeat co- testing at 12 and 24 months

  • Both negative: re-test in 3 years
  • Abnormal: repeat colposcopy with ECC
  • Continue age appropriate screening for at least 20 years even if > 65
(+) margins after LEEP
   -Repeat cytology and ECC at 4 – 6 months
Persistent CIN 2+ following LEEP
   -Repeat LEEP
   -Hysterectomy
54
Q

What is the 2nd most coomon cancer in women worldwide?

A

Cervical Cancer

55
Q

What is the clinical presentation for cervical Cancer?

A
  • Frequently ASYMPTOMATIC
  • 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
56
Q

What is most common clinical symptom for Cervical Cancer?

A

Abnormal vaginal bleeding

Foundations 3 (25 decks)

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