Dobbs - Cervical Cancer Screening

Question 1

is cervical ca curable

Answer 1

yes → 95% of early cases

Question 2

90% of invasive cervical carcinomas show

Answer 2

presence of HPV

Question 3

lifetime cumulative risk of acquiring HPV in sexually active persons

Answer 3

50-80

Question 4

which types of hpv cause cervical ca

Answer 4

16

18

Question 5

hpv 6 and 11 are associated w.

Answer 5

condyloma acuminata

Question 6

2 high risk factors for cervical neoplasia

Answer 6

immunosuppression → HIV, transplant, other

DES exposure

Question 7

spectrum of hpv (5)

Answer 7

condyloma

mild dysplasia → CIN 1

moderate dysplasia → CIN 2

severe dysplasia → CIN 3

cervical ca, carcinoma in situ (CIS)

Question 8

where columnar endocervical cells transform into squamous epithelial ectocervical cells

Answer 8

transformation zone

Question 9

concerning findings w. transformation zone

Answer 9

friable

Question 10

disordered growth of epithelial lining of cervix

Answer 10

CIN (cervical intraepithelial neoplasia)

Question 11

mild dysplasia, disordered growth of lower ⅓ of epithelial lining

Answer 11

CIN 1

Question 12

moderate dysplasia, abnormal maturation of lower ⅔ of lining

Answer 12

CIN 2

Question 13

severe dysplasia, encompasses more than ⅔ of epithelial thickness

Answer 13

CIN 3

Question 14

full thickness of cervix

Answer 14

CIS (carcinoma in situ)

Question 15

beyond cervix to uterus to pelvic walls/vagina to lymph nodes to bladder/rectum to distant sites

Answer 15

cervical ca

Question 16

cervical ca is very rare in pt’s <

Answer 16

40 yo

Question 17

common sites of metastasis for cervical ca (2)

Answer 17

lung

bones

Question 18

sx of cervical ca (5)

Answer 18

post coital bleeding

abnormal bleeding

friable

vaginal d.c (watery, mucoid, purulent, malodorous)

+/- visualized tumor

Question 19

mc type of cervical ca

Answer 19

squamous cell → 80%

Question 20

less common form of cervical ca

Answer 20

adenocarcinoma → 20%

Question 21

is a PAP smear a diagnostic test

Answer 21

no! → just detects premalignant/malignant cell changes

Question 22

sampling of cervical cells from transformation zone

Answer 22

pap smear

Question 23

junction of endocervix and ectocervix

Answer 23

transformation zone

Question 24

bethesda classification

Answer 24

1. satisfactory vs unsatisfactory
2. NILM (negative for intraepithelial lesion or malignancy)
3. squamous cell
4. glandular cell

Question 25

examples of “unsatisfactory” finding

Answer 25

blood inflammation bacteria lubricant

Question 26

squamous classifications range from \_\_ to \_\_

Answer 26

atypical squamous cells (ASC) → squamous cell carcinoma

Question 27

glandular cell classification ranges from \_\_ to \_\_

Answer 27

atypical glandular cells → adenocarcinoma

Question 28

cervical ca screening guidelines are based on (2)

Answer 28

presence of cervix no s/s of cervical ca

Question 29

do the cervical screening guidelines take into account sexual hx or hpv vaccination status

Answer 29

no!

Question 30

cervical screening guidelines for pt's under 21 yo

Answer 30

no screening

Question 31

consequences of screening adolescents

Answer 31

anxiety cost overuse of follow-up procedures → additional testing → unnecessary tx

Question 32

tx for CIN1 increases risk for

Answer 32

preterm birth low birthweight preterm premature rupture of membranes (PPROM)

Question 33

cervical screening guidelines for 21-29 yo

Answer 33

pap smear alone q 3 years OR primary hrHPV testing starting at 25 every 5 years in average risk pt's 25-29 yo

Question 34

cervical ca screening guidelines for 30-65 yo

Answer 34

any one of: cytology alone q 3 years FDA-approved primary hrHPV testing alone q 5 years cotesting q 5 years

Question 35

what is cotesting

Answer 35

hrHPV testing PLUS cytology

Question 36

cervical ca screening guidelines for \> 65 yo

Answer 36

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

Question 37

repeat HPV testing or cotesting is recommended for pt w. minor screening abnormalities indicating HPV infxn w. low risk of underlying C1N 3 at

Answer 37

1 year

Question 38

for pregnant women 25 yo and older, expedited tx is recommended when

Answer 38

HPV infx w. low risk of underlying CIN 3+ \> 60%

Question 39

\_\_ tx is preferred to \_\_ tx for histologic HSIL

Answer 39

excisional preferred over ablative

Question 40

continued surveillance w. HPV testing or cotesting at __ intervals for \_\_ years is recommended post-tx of histologic HSIL

Answer 40

3 25

Question 41

when is cytology recommended for surveillance of HPV

Answer 41

when other testing is not available

Question 42

tx for CIN 2 or CIN 3

Answer 42

LEEP (loop electrosurgical excision procedure) *outpatient*

Question 43

what tx requires hospitalization

Answer 43

cone bx

Question 44

HPV 11

Answer 44

condyloma

Question 45

who is gardasil approved for

Answer 45

9-45 yo all girls and boys

Question 46

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

Answer 46

PAP