Monday, 2-27-Pap smear, cervical dysplasia, and cancer (Wootton) Flashcards
site where greater than 90% of cervical neoplasias arise?
Squamocolumnar junction
the majority of cervical cancers and CIN are caused by these HPVs?
HPV 16 and 18 responsible for ~70% of cervical CA
Risk factors for cervical neoplasia?
- more than 1 sexual partner or male sexual partner who has had sex with >1 person
- young age at 1st intercourse or pregnancy
- smoking
- HIV
- organ transplant
- STIs
- DES exposure
- infrequent or absent pap screening tests
- high parity
- lower SES
PAP screening guidelines for under 21 yrs?
No screening
PAP screening guidelines for age 21-29?
cytology alone every 3 yrs
PAP screening guidelines for ages 30-65?
HPV and cytology “cotesting” every 5 yrs (preferred)
PAP screening guidelines for 65+?
no screening following adequate negative prior screening
PAP screening after hysterectomy?
no screening
what is the next step in management of Atypical Squamous cells of undetermined significance (ASC-US)?
- HPV testing (preferred) —> if HPV + —> Colposcopy –> manage per ASCCP guideline
- Repeat cytology (@1 yr acceptable) –> If more ASC —> colposcopy –> manage per ASCCP guidelines
what is the next step in management of women with LSI with negative HPV OR no HPV test done OR with + HPV test?
colposcopy
gold standard for Dx and tx planning in cervical CA?
colposcopy
- must visualize entire squamocolumnar junction
- look for acetowhite changes, punctuations, mosaicism, abnormal vessels, masses (in order of severity of disease)
- directed biopsies and endocervical curettage
when are excisional techniques utilized for tx of cervical CA?
- endocervical curettage is postiive (needs cold knife cone)
- unsatisfactory colposcopy (No SCJ)
- substantial discrepancy between pap and biopsy (i.e., high grade pap and neg. colposcopy)
risks of excisional procedures?
- INCREASED RISK OF PRETERM PREMATURE RUPTURE OF MEMBRANES (PPROM)
- OPERATIVE RISKS-BLEEDING, INFX
- increased risk of cervical incompetence and resultant 2nd trimester pregnancy loss
- cervical stenosis
91% of cervical CA is caused by HPV and 80% of cases are ___ carcinomas
squamous cell
-adenocarcinoma/adenosquamous make up 15%
for clinical evalulation of cervical neoplasia:
- symptoms?
- spread?
- staging?
symptoms: watery vaginal bleeding, postcoital bleeding, intermittent spotting
spread: direct invasion and lymphatic spread
staged: clinically (PE, radiology-chest and skeletal xrays, IVP; cytoscopy; sigmoidoscopy, LFTs
