Pap Smear and Cervical CA Flashcards
What area of the cervix is a sample taken from during a routine pap smear?
Squamocolumnar Junction- site of 90% of neoplasias
How does the transformation zone change with age?
During reproductive years, the zone everts, and then in menopause retracts back
Describe HPV micro
Double stranded-DNA
Circular
Icosahedral
Non-enveloped
Which strains of HPV cause condyloma Acuminata?
6 11
Which strains of HPV are associated with malignancy?
16, 18, 31, 45
How does HPV cause carcinoma?
E6 inhibits p53
E7 knocks out Rb via p21 inhibition
Risk factors for Cervical neoplasia
Young coitarche Smoking Multiple sex partners Immunocompromised DES exposure
For a 21-29 year old female, how often should she have a Pap?
3 years
30-65 year old guidelines for Pap and HPV
Co-test every 5
At what age can you stop screening if negative results?
65 or after hysterectomy
What else can a pap smear test for?
Organisms: Trichomonas, Gardnerella, Candida
Non-neoplastic findings: Inflammation, IUD, Atrophy
Cytology categories for epithelial abnormalities
Low grade squamous intraepithelial lesion (LSIL)
High grade SIL (HSIL)
SCC
What is the next step in a patient <25y with ASC-H or HSIL?
Colposcopy
In a patient with LSIL, what determines if a colposcopy is indicated?
HPV status
Yes= Colposcopy
No= repeat testing at 1 year
Treatment options for HSIL
LEEP or Colposcopy first then decide
