Dobbs - Cervical Cancer Screening Flashcards
is cervical ca curable
yes → 95% of early cases
90% of invasive cervical carcinomas show
presence of HPV
lifetime cumulative risk of acquiring HPV in sexually active persons
50-80
which types of hpv cause cervical ca
16
18
hpv 6 and 11 are associated w.
condyloma acuminata
2 high risk factors for cervical neoplasia
immunosuppression → HIV, transplant, other
DES exposure
spectrum of hpv (5)
condyloma
mild dysplasia → CIN 1
moderate dysplasia → CIN 2
severe dysplasia → CIN 3
cervical ca, carcinoma in situ (CIS)
where columnar endocervical cells transform into squamous epithelial ectocervical cells
transformation zone
concerning findings w. transformation zone
friable
disordered growth of epithelial lining of cervix
CIN (cervical intraepithelial neoplasia)
mild dysplasia, disordered growth of lower ⅓ of epithelial lining
CIN 1
moderate dysplasia, abnormal maturation of lower ⅔ of lining
CIN 2
severe dysplasia, encompasses more than ⅔ of epithelial thickness
CIN 3
full thickness of cervix
CIS (carcinoma in situ)
beyond cervix to uterus to pelvic walls/vagina to lymph nodes to bladder/rectum to distant sites
cervical ca
cervical ca is very rare in pt’s <
40 yo
common sites of metastasis for cervical ca (2)
lung
bones
sx of cervical ca (5)
post coital bleeding
abnormal bleeding
friable
vaginal d.c (watery, mucoid, purulent, malodorous)
+/- visualized tumor
mc type of cervical ca
squamous cell → 80%
less common form of cervical ca
adenocarcinoma → 20%
is a PAP smear a diagnostic test
no! → just detects premalignant/malignant cell changes
sampling of cervical cells from transformation zone
pap smear
junction of endocervix and ectocervix
transformation zone
bethesda classification
- satisfactory vs unsatisfactory
- NILM (negative for intraepithelial lesion or malignancy)
- squamous cell
- glandular cell
examples of “unsatisfactory” finding
blood
inflammation
bacteria
lubricant
squamous classifications range from __
to __
atypical squamous cells (ASC) → squamous cell carcinoma
glandular cell classification ranges from __
to __
atypical glandular cells → adenocarcinoma
cervical ca screening guidelines are based on (2)
presence of cervix
no s/s of cervical ca
do the cervical screening guidelines take into account sexual hx or hpv vaccination status
no!
cervical screening guidelines for pt’s under 21 yo
no screening
consequences of screening adolescents
anxiety
cost
overuse of follow-up procedures → additional testing → unnecessary tx
tx for CIN1 increases risk for
preterm birth
low birthweight
preterm premature rupture of membranes (PPROM)
cervical screening guidelines for 21-29 yo
pap smear alone q 3 years
OR
primary hrHPV testing starting at 25 every 5 years in average risk pt’s 25-29 yo
cervical ca screening guidelines for 30-65 yo
any one of:
cytology alone q 3 years
FDA-approved primary hrHPV testing alone q 5 years
cotesting q 5 years
what is cotesting
hrHPV testing
PLUS
cytology
cervical ca screening guidelines for > 65 yo
no screening after adequate negative prior screenings in last 10 years
no screening w. hysterectomy w. removal of cervix and no hx of high-grade cervical precancerous lesions or cervical ca
repeat HPV testing or cotesting is recommended for pt w. minor screening abnormalities indicating HPV infxn w. low risk of underlying C1N 3 at
1 year
for pregnant women 25 yo and older, expedited tx is recommended when
HPV infx w. low risk of underlying CIN 3+ > 60%
__ tx is preferred to
__ tx for histologic HSIL
excisional preferred over ablative
continued surveillance w. HPV testing or cotesting at __ intervals for
__ years is recommended post-tx of histologic HSIL
3
25
when is cytology recommended for surveillance of HPV
when other testing is not available
tx for CIN 2 or CIN 3
LEEP (loop electrosurgical excision procedure)
outpatient
what tx requires hospitalization
cone bx
HPV 11
condyloma
who is gardasil approved for
9-45 yo
all girls and boys
a 34 yo w. G2P2 presents vaginal d.c, dysuria, dypareunia - what test is not recommended
a. chlamydia
b. gonorrhea
c. pap
d. urine
e. wet prep
PAP
