Pap Smear

Question 1

What are the two types of epithelial tissue near the cervicial os?

Answer 1

• Columnar and stratified nonkeratinizing squamous epithelia

Question 2

Where does a majority of cervical neoplasia arise?

Answer 2

• Squamocolumnar junction

Question 3

What is HPV?

Answer 3

• Cervical cancer and CIN are caused by HPV
• About 100 types and 30 of them affect anogenital tract
• 15 are associated with cancer and called high risk types

Question 4

What types of HPV cause a majority of cancers??

Answer 4

• 16, 18, 31, and 45

Question 5

What types of HPV are associated with genital warts and low grade lesions?

Answer 5

• 6 and 11`

Question 6

What are some risk factors for cervical neoplasias?

Answer 6

• Multiple sexual partners or sexual partner who has multiple sexual partners
• Young age at first intercourse or pregnancy
• Smoking
• HIV
• Organ transplant
• STI
• Diethylstilbestrol exposure
• Infrequent or absent pap screening tests
• High parity
• Lower socioeconomic status

Question 7

How often are pap smears done? What is management?

Answer 7

• Every 5 years

- Based on what the 5 year risk of developing CIN 3

Question 8

When is the youngest age of someone who needs HPV screening?

Answer 8

• At least 21

Question 9

What are the screening guidelines for someone 21-29?

Answer 9

• Cytology alone every 3 years

Question 10

What are the screen guidelines for someone 30-65?

Answer 10

• HPV and cytology “cotesting” every 5 years

Question 11

What are the screening guidelines for someone 65 and older?

Answer 11

• No screening following adequate negative

Question 12

What is the specimen type for the bethesda system?

Answer 12

• Conventional or liquid based

Question 13

What are the general categorization for the bethesda system?

Answer 13

• Negative for intraepithelial lesion or malignancy
• Epithelial cell abnormality: see interpretation/result
• Other: see interpretation/result (endometrial cells in a woman older than 40 years of age)

Question 14

What organisms could be seen causing an abnormal screen?

Answer 14

• Trichomonas
• Candida
• Shift in bacterial flora suggestive of bacterial vaginosis
• Bacterial morphologically consistent with actinomyces
• Cellular changes consistent with HSV

Question 15

What are some other non-neoplastic findings on an abnormal screen?

Answer 15

• Reactive cellular changes associated with inflammation, radiation, intrauterine contraceptive device
• Glandular cells status post hysterectomy
• Atrophy

Question 16

What are some squamous cell lesions?

Answer 16

• Atypical squamous cells of undetermined significance (ASC-US)
• Low grade squamous intraepithelial lesion (LSIL)
• High grade squamous intraepithelial lesion (HSIL)
• Squamous cell carcinoma

Question 17

What are some glandular cell lesions?

Answer 17

• Atypical endocervical, endometrial, glandular
• Endocervical adenocarcinoma in situ
• Adenocarcinoma: endocervical, endometrial, extrauterine, NOS

Question 18

What is the management of a patient <25 years old with ASC-US or LSIL?

Answer 18

• If ASC-US only and HPV negative, routine screening

- IF ASC-US and HPV positive, repeat cytology at one year

Question 19

What is the management of a patient <25 years old with ASC-H or HSIL?

Answer 19

• Colposcopy

Question 20

What is the management of HSIL?

Answer 20

• Immediate LEEP

- Colposcopy

Question 21

What is a colposcopy?

Answer 21

• Binocular stereomicroscope with variable magnification
• Gold standard for diagnosis and treatment planning
• Cervix is washed with 3% acetic acid which dehydrates cells making the large nuclei of abnormal cells turn white

Question 22

What are you looking for during a colposcopy?

Answer 22

• Acetowhite changes
• Punctuations
• Mosaicism
• Abnormal vessels
• Masses

Question 23

What are some treatment options for cervical cancer?

Answer 23

• Ablative (destroy cervical tissue): cryotherapy and laser ablation
• Excisional: cold knife cone or loop electrode excisional procedure (LEEP)

Question 24

What is a problem with ablative treatment for cervical cancer?

Answer 24

• Do not know if cancer is gone or if you got all the cells

Question 25

When is an excisional treatment technique done?

Answer 25

• Endocervical curettage positive
• Unsatisfactory colposcopy
• Substantial discrepancy between pap and biopsy

Question 26

What are some risks of excisional procedures?

Answer 26

• Increased risk of cervical incompetence and resultant second trimester pregnancy loss
• Increased risk of preterm premature rupture of membranes (PPROM)
• Cervical stenosis
• Operative risks - Bleeding and infections

Question 27

What are some clinical symptoms of cervical cancer?

Answer 27

• Watery vaginal bleeding
• Bleeding after intercourse
• Intermittent spotting

Question 28

What are some preventative measures taken for cervical cancer?

Answer 28

• Sexual abstinence/limiting number of partners
• Use of barrier protection
• Regular exams and pap smears
• Vaccination with the HPV vaccine

Question 29

What is the vaccination schedule for HPV?

Answer 29

• First dose
• Second dose two months later
• Third dose 6 months from first

Question 30

Who is the HPV vaccine recommended for?

Answer 30

• All girls and boys 9-26
• Can receive if have abnormal pap
• Not for use in pregnancy but safe in breastfeeding

Question 31

What are some side effects of the HPV vaccine?

Answer 31

• Syncope
• Dizziness
• Nausea
• Headache
• Fever
• Injection site reactions