Lecture 22: Cervical Cancer CPC, HPV, Pap Smear Screeniing, Diagnosis, Treatment and HPV vaccine Flashcards
What is the incidence of invasive cervical cancer?
450,000 new cases per year
10 million HSIL
30 million LSIL
What is the most important etiologic agent in cervical cancer?
HPV is the most important etiologic agent in cervical cancer
Is HPV sufficient to result in cervical cancer?
HPV is very common, and is not sufficient to result in cervical cancer
What is the significance of Pap smear screening?
Lack of screening and/or lack of recent screening account for ~60% cases of cervical cancer in the US
What is the importance of a colposcopy and directed biopsy?
Colposcopic examination and biopsy is critical in determining management of an ABNORMAL Pap smear and to rule out cancer
What is the role of HPV reflex testing?
HPV high risk reflex testing for ASC-US has resulted in improved sensitivity for CIN3+ and cost savings to the healthcare system
How do you best screen for cervical cancer?
HPV testing in conjunction with cytology in women > or equal 30 results in greater sensitivity than either test alone and has tremendous negative predictive value which can lead to increased screening intervals
What is the HPV vaccine made of?
HPV vaccine is a prophylactic vaccine made from non-infectious viral like particles intended to prevent HPV infection in non-exposed girls and boys
Is Cervical cancer preventable and curable?
Yes
What is cotest?
Cytology + High Risk HPV DNA
What is the role of HPV co-testing?
Inconjunction with pap smear
Increases detection of CIN 3 with concomitant decrease in CIN 3+
Can increase pap screening interval to every 5 years if both results are negative
Enhances ID of adenocarcinoma
Cytology has been ineffective at reducing rates of adenocarcinoma
What is a colposcopy?
An optical instrument that uses light and magnification to evaluate the cervical epithelium and sub-epithelial blood vessels
What are the objectives of the colposcopy?
- Visualize the cervix, vagina, vulva and perianal area
- Identify the SCJ (squamo-columnar junction) and the transformation zone
- Determine if satisfactory or not
- ID and assess size, shape, contour, location and extent of precancerous (neoplastic) lesions
- Possible sampling of the endocervical canal
- Biopsy most severe lesions
- Correlate pap smear, biopsy and colposcopic impression
- plan therapy
- communicate with patient
What are the harms of screening?
- Psychosocial impact of positive screens (stigmatization)
- additional clinical visits
- Additional procedures
- Additional treatment of lesions that may have been destined to resolve
- Adverse reproductive outcomes with treatment
Most HPV infections do what?
Cleared by host immune response by 3 years
Those that persist may regress, persist or progress
