Lecture 2: Pap Smear, Cervical Dysplasia, Cancer Flashcards
Which strains of HPV cause the majority of cancers?
HPV 16, 18, 31, and 45
What are the risk factors for cervical neoplasia?
- Multiple sexual partners
- Young age at first intercourse
- Smoking
- HIV + Organ transplant
- STI’s
- DES exposure
- High parity
What are the pap smear screening guidelines based on age?
- Under 21 = no screening
- 21-29 y/o = cytology alone every 3 years
- 30-65 y/o = HPV and Cytology “cotesting” every 5 years (preferred)
- 65+ y/o = no screening following adequate negative prior screening
What are the pap smear screening guidelines following hysterectomy?
No screening
If 40 y/o patient had an HPV status that was unknown on her last pap result when would she need another pap?
3 years when unknown
What can the 2001 Bethesda System tell us about a pap smear?
- Specimen type
- Specimen adequacy = satisfactory or unsatisfactory (not enough cells)
- General categorization
- Organisms
- Other non neoplastic findings: inflammation, radiation, IUD
- Epithelial cell abnormalities
What are the guidelines for managment of a women w/ atypical squamous cells of undetermined significance (ASC-US) on cytology?
HPV testing (perferred) or Repeat cytology at 1 year
What are the guidelines for managment of a women w/ atypical squamous cells of undetermined significance (ASC-US) after repeat cytology at 1-year if result is negative or ≥ASC is found?
- Negative: then back to routine screening
- ≥ASC: then do colposcopy
What are the guidelines for managment of a women w/ atypical squamous cells of undetermined significance (ASC-US) if HPV testing is positive vs. negative?
- Positive = managed same as LSIL —> colposcopy
- Negative = repeat cotesting at 3 years
What are the guidelines for managment of a women w/ LSIL and negative HPV test?
- Repeat co-testing at 1 year (preferred), but colposcopy is acceptable
- If cytology and HPV negative —> repeat at 3 years
- If ≥ASC or HPV positive –> then colposcopy
What are the guidelines for managment of a women w/ LSIL and no HPV test or LSIL with a positive HPV test?
Colposcopy
What are the guidelines for managment of a women w/ HSIL?
- Immediate loop electrosurgical excision
or
- Colposcopy (w/ endocervical assessment)
What is the gold standard for diagnosis and treatment planning of abnormal pap smear?
Colposcopy w/ directed biopsy
What are the abnormalities you are looking for on Colposcopy?
- Acetowhite changes
- Punctuations (tiny blood vessels)
- Mosaicism
- Abnormal blood vessels
- Masses
What are 3 instances when excisional techniques are done for cervical neoplasia?
- Endocervical curettage positive (needs cold knife cone)
- Unsatisfactory colposcopy (No SCJ)
- Substantial discrepancy btw pap and biopsy (i.e., high grade pap and negative colposcopy)
What are the 2 ablative techniques for cervical neoplasia?
- Cryotherapy
- Laser ablation
What are 4 risks associated with excisional procedures for cervical neoplasia?
- ↑ risk of cervical incompetence and resultant 2nd trimester pregnancy loss
- ↑ risk of preterm premature rupture of membranes (PPROM)
- Cervical stenosis
- Operative risks –> bleeding, infection…
How is cervical carcinoma staged?
- Clinically by:
- PE
- Radiologic exams –> CXR and skeletal XR’s + intravenous pyelogram
- Cystoscopy
- Sigmoidoscopy
- Liver function studies
What are the recommendations for the HPV vaccine?
- All girls and boys ages 9-26 y/o
- Approved for use in men and women 27-45 y/o
How many injections are in a series of HPV vaccine and what is the recommendation for scheduling?
- 3 injection series:
- 1st dose
- 2nd dose 2 months later
- 3rd dose 6 months from the first (can still be given if interval varies)
- In children <15 y/o give 2 doses separated by 6-12 month
If a patient already has an abnormal pap can they receive an HPV vaccine; what about during pregnancy and breast feeding?
- Can receive if already have abnormal pap
- NOT for use in pregnancy, but safe in breastfeeding
