Exam 2 Cervical Dz Flashcards
Cervical cells: Inside cervix?
Outside cervix?
Inside = columnar epith
Outside = squamous epith
Cervical Intraepithelial Neoplasia (CIN):
High-grade lesions U seen in what age group?
Invasive CA U seen in what age group?
25-35yo
> 40yo
CIN caused by?
HVP:
16/18 = high risk
6/11 = low risk
CIN risk factors? (6)
HIV/Immunosupp Smoking Sluts Early sex Long-term oral contr STds
CIN screening initiated?
21 regardless of sex activity
EXCEPT <21 HIV+ or chronic suppressive therapy
CIN screening F/U? (4)
21-29 yo: cytology only Q 3yrs, NO HPV testing
30-65 yo: Cytology + HPV Q 5 yrs
High risk: yearly
HIV: 1st at time of dx, then Q 6 mo x 2, then annually
Diethylstilbestrol is?
Why do we care?
Med given to preggos in 70s
Causes vag/cerv CA, BCA, infert
Cervical CA screening stopped when?
65yo IF in past 10 yrs: 3 consecutive neg cytology results OR 2 consec neg co-testing WITH most recent w/i 5 yrs AND not high risk
Cervical CA screening for hysterectomy?
Stop at removal u/l _hx of CIN2/3,
then annual x 20 yrs regardless of age
Specimen for cervical cytology must include?
endocervical/transformation zone
Cervical Cytology: ASC-US is?
Next step in testing?
Atypical cells of u/k significance
Must reflex to HPV DNA:
Neg = N
+ = colposcopy if > 24yo
ASC-US w/o HPV caused by?
Inflamm
Vulvovaginal atrophy
ASC-US in 21-24yo?
repeat cytology at 12 mo
Cervical Cytology: Low-Grade Squamous Intraep Lesion (LSIL) next step in testing?
> 24yo?
21-24yo?
Assume HPV DNA ∴ no HVP test until post-meno
Colposcopy
Repeat cytology 12 mo
LSIL presentation?
U similar to CIN I
Enlarged, hyperchromatic nuclei w/ abundant cytoplasm
Cervical Cytology: High-Grade Squamous Intraep Lesions (HSIL) next step testing?
Assume HPV
REFER all ages for colposcopy
HSIL presentation?
U similar to CIN2/3, AIS
Enlarged, hyperchromatic nuclei w/ little or no cytoplasm
30-65yo w/ neg Cytology + high risk for HPV, next step testing?
HPV DNA typing for 16/18
OR
Repeat co-test in 12 mo (not 5 yrs)
Endocervical cells on pap indicate?
Only reported if 40+yo
P normal or pathological shedding
Relate to menstrual hx
CIN Type 1?
Lower 1/3 of epith lining
Seen w/ LSIL
U regress in 12 mo
CIN Type 2?
Lower 2/3 of epith lining
Seen w/ HSIL
1/2 regress, 20% to Type 3, 5% to invasive CA
CIN Type 3?
More than 2/3 of epith lining
Seen w/ HSIL
1/2 regress, 40% to CA
Colposcopy: Satisfactory when?
Unsatisfactory when?
Next step?
Complete visualization of transf zone
Incomp vis of tranf zone ->
Must endocervical curettage
CIN tx: Ablation?
F/U? (2)
S/E? (4)
NO2 destruction (CIN 1 only)
No sex 4 wks
Healed by 8 wks
Uterine cramping
Profuse, smelly, watery d/c for 4 wks
Cervical stenosis
Less bad preggo outcomes than other tx
CIN tx: Excision?
F/U?
S/E?
Loop Electrosurgical Excision Procedure (LEEP)
No heavy lifting
No sex 4 wks
Stinky d/c 3 wks
Ist period post is heavier
Obliterated/Incomplete/Stenotic cervix
Pre-term delivery
AdenoCA in situ (AIS) is? (5)
Aggressive precursor to cervical adenoCA U by 37yo U AGS/HSIL Endocervical gland involvement w/ atypical columnar epith U high in canal w/ skip lesions
AIS diagnostics?
Colpo w/ endocervical curettage and bx
AIS tx?
Cold knife conization
Hysterectomy
Cervical CA?
U by 50yo
U HPV 16 SCC (worst)
P HPV 18 AdenoCA
Cervical CA presentation? (5)
Asympt U Abn vag bleeding Post sex bleeding Unilat pelvic pain, rad to hip/thigh Vag d/c
Cervical CA tx?
From cold knife to hyst w/ chemo/radio
Cervical CA f/u? (3)
Q 4mo x 2 yrs, then Q 6mo x 3 yrs
Annual pap
Annual CXR x 5 yrs
Cervical CA prevention? (5)
HPV vaccine No sex Barrier protection Reg paps Tx pre-cancers
