Pap and Cervical Cancer - Wootton

Question 1

90% of cervical neoplasia arises where?

Answer 1

SC junction - transformation zone

Question 2

Major causes of cervical cancer

Answer 2

HPV 16, 18, 31, 45

Question 3

Risk factors for cervical neoplasia

Answer 3

• Sex w/ multiple people
• Sex w/ cervical cancer person
• Smoking
• HIV
• Organ transplant
• STI
• DES
• Hx of it or high grade lesion
• Infrequent/absent paps

Question 4

Only constant modifiable risk factor for cervical cancer

Answer 4

Smoking

Question 5

• **Pap smear frequency for…
  
  • Under 21
  • 21-29
  • 30-65
  • 65+
  • Post-hysterectomy

Exceptions?

Answer 5

• None
• Cytology every 3 years
• HPV + cytology every 5 years
• None after adequate negative
• None

Previous positives, multiple sexual partners

Question 6

19, G0, 1 sexual partner, smoker, depression, FHx of cervical cancer, FHx of diabetes…

Greatest risk for cervical cancer?

Pap smear?

Answer 6

Smoker

No (under 21)

Question 7

40, AA, normal pap last year…

Next pap?

If HPV was unknown on last pap, when would she need next pap?

Answer 7

4 years (5 from negative)

4 years still

Question 8

Which is better pap collection method: conventional of liquid-based?

Why?

Answer 8

Liquid based

Easier and can do while on period

Question 9

Cervical biopsy comes back as positive for intraepithelial lesion (HPV). Now what?

Answer 9

Colposcopy –> acetic acid wash –> large nuclei of abnormal cells become white

Question 10

Looking for what things on colposcopy of cervix? (in order of best to worst)

Answer 10

• Acetowhite changes
• Punctations
• Mosaicism
• Abnormal vessels
• Masses

Question 11

Nabothian cyst - what is it?

Answer 11

Plugged mucus gland (like a zit) on the cervix - NORMAL

Question 12

Abnormal vessels on cervix will look like what?

Answer 12

Straight, running perpendicular to Os

Question 13

34, pap smear had low grade squamous intraepithelial lesion w/ positive high grade HPV. Next step?

Vaccine?

Answer 13

Biopsy (in 30s now)

Too late (to 26)

Question 14

When do you treat the cervix?

Answer 14

CIN 2 or worse

Question 15

Positive vs. negative endocervix – treatments?

Answer 15

Positive – Cold knife cone (CKC)

Negative – LEEP (loop electrode excisional procedure)

Question 16

Bad things about cryotherapy

Answer 16

• No margins to check after

- Lots of clear discharge after

Question 17

3 times to do excisional biopsy of cervix

Answer 17

• Positive endocervical curettage (ECC)
• Unsatisfactory colposcopy (no SCJ)
• Big discrepancy between pap and biopsy (high grade pap vs. normal colp)

Question 18

4 risks of doing excisional cervical procedures

Answer 18

• Risk of cervical incompetence (prolapse – 2nd trimester loss)
• Risk of preterm premature rupture
• Cervical stenosis
• Bleeding/infection

Question 19

Most cervical cancers are what?

Answer 19

HPV-caused SCC

Question 20

A patient has a pap smear positive for high grade SIL. When might transformation to cancer occur?

Answer 20

10 years later

Question 21

Watery vaginal bleeding, bleeding after intercourse, intermittent spotting, particular odor

Answer 21

Cervical cancer

Question 22

Treatment of cervical cancer…

• Microinvasive
• Invasive (1a2)
• Bulky (1b, 2a)
• Stage 2b +

Answer 22

• CKC or hysterectomy
• Radial hysterectomy w/ LN dissection
• Radical hysterectomy w/ LN dissection, or radiation and cisplatin chemo
• External beam radiation and cisplatin chemo

Question 23

4 ways to prevent HPV/cancer

Answer 23

• Abstinence or small #
• Barrier protection
• Regular exams/paps
• HPV vaccine

Question 24

Ages for HPV vaccine (Gardasil)

Answer 24

9-26 (boys and girls)

Question 25

HPV vaccine - pregnancy?

Answer 25

NO, but ok in breastfeeding

Question 26

A patient has an abnormal pap – can they still get the HPV vaccine?

Answer 26

YES

Question 27

Cervarix - for who?

Protects from what?

Answer 27

GIRLS 9-25

16 and 18

Question 28

Side effects of HPV vaccine

Answer 28

Syncope, dizziness, nausea, headache, fever, injection site reactions