Pap Smear Flashcards
What are the two types of epithelial tissue near the cervicial os?
- Columnar and stratified nonkeratinizing squamous epithelia
Where does a majority of cervical neoplasia arise?
- Squamocolumnar junction
What is HPV?
- 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
What types of HPV cause a majority of cancers??
- 16, 18, 31, and 45
What types of HPV are associated with genital warts and low grade lesions?
- 6 and 11`
What are some risk factors for cervical neoplasias?
- 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
How often are pap smears done? What is management?
- Every 5 years
- Based on what the 5 year risk of developing CIN 3
When is the youngest age of someone who needs HPV screening?
- At least 21
What are the screening guidelines for someone 21-29?
- Cytology alone every 3 years
What are the screen guidelines for someone 30-65?
- HPV and cytology “cotesting” every 5 years
What are the screening guidelines for someone 65 and older?
- No screening following adequate negative
What is the specimen type for the bethesda system?
- Conventional or liquid based
What are the general categorization for the bethesda system?
- 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)
What organisms could be seen causing an abnormal screen?
- Trichomonas
- Candida
- Shift in bacterial flora suggestive of bacterial vaginosis
- Bacterial morphologically consistent with actinomyces
- Cellular changes consistent with HSV
What are some other non-neoplastic findings on an abnormal screen?
- Reactive cellular changes associated with inflammation, radiation, intrauterine contraceptive device
- Glandular cells status post hysterectomy
- Atrophy
What are some squamous cell lesions?
- Atypical squamous cells of undetermined significance (ASC-US)
- Low grade squamous intraepithelial lesion (LSIL)
- High grade squamous intraepithelial lesion (HSIL)
- Squamous cell carcinoma
What are some glandular cell lesions?
- Atypical endocervical, endometrial, glandular
- Endocervical adenocarcinoma in situ
- Adenocarcinoma: endocervical, endometrial, extrauterine, NOS
What is the management of a patient <25 years old with ASC-US or LSIL?
- If ASC-US only and HPV negative, routine screening
- IF ASC-US and HPV positive, repeat cytology at one year
What is the management of a patient <25 years old with ASC-H or HSIL?
- Colposcopy
What is the management of HSIL?
- Immediate LEEP
- Colposcopy
What is a colposcopy?
- 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
What are you looking for during a colposcopy?
- Acetowhite changes
- Punctuations
- Mosaicism
- Abnormal vessels
- Masses
What are some treatment options for cervical cancer?
- Ablative (destroy cervical tissue): cryotherapy and laser ablation
- Excisional: cold knife cone or loop electrode excisional procedure (LEEP)
What is a problem with ablative treatment for cervical cancer?
- Do not know if cancer is gone or if you got all the cells
When is an excisional treatment technique done?
- Endocervical curettage positive
- Unsatisfactory colposcopy
- Substantial discrepancy between pap and biopsy
What are some risks of excisional procedures?
- 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
What are some clinical symptoms of cervical cancer?
- Watery vaginal bleeding
- Bleeding after intercourse
- Intermittent spotting
What are some preventative measures taken for cervical cancer?
- Sexual abstinence/limiting number of partners
- Use of barrier protection
- Regular exams and pap smears
- Vaccination with the HPV vaccine
What is the vaccination schedule for HPV?
- First dose
- Second dose two months later
- Third dose 6 months from first
Who is the HPV vaccine recommended for?
- All girls and boys 9-26
- Can receive if have abnormal pap
- Not for use in pregnancy but safe in breastfeeding
What are some side effects of the HPV vaccine?
- Syncope
- Dizziness
- Nausea
- Headache
- Fever
- Injection site reactions
