PAP Smear, Cervical Dysplasia/Cancer

Question 1

What type of epithelium lines the Endocervix?

Answer 1

Columnar

Question 2

What type of epithelium lines the Ectocervix?

Answer 2

Stratified Nonkeratinizing Squamous

Question 3

Where do most of the Cervical Neoplasias arise?

Answer 3

Squamocolumnar Junction = Transformation Zone

Question 4

The cervical Transformation zone location depends on age, when is it most easily accessible?

Answer 4

Reproductive years

Question 5

What causes Cervical Cancer?

Answer 5

HPV

Question 6

What are the High Risk strains of HPV that commonly cause cervical cancer?

Answer 6

16
18
31
45

Question 7

What are some risks for developing Cervical Cancer?

Answer 7

• Smoking
• Multiple sexual partners, STI, HIV
• Infrequent PAP screens

Question 8

What are some risks for developing Cervical Cancer?

Answer 8

• Smoking
• Multiple sexual partners, STI, HIV
• Infrequent PAP screens

Question 9

What is the guidelines for screening for 21-29 years old?

Answer 9

Cytology every 3 years if normal

Question 10

What is the guidelines for screening for 30-65 years old?

Answer 10

Cotesting

= HPV + Cytology every 5 years if normal

Question 11

What is the guidelines for screening if above 65 years old and if a patient has had a hysterectomy?

Answer 11

No screening if normal

Question 12

At what age are PAP smears recommended?

Answer 12

21

Question 13

If the PAP comes back negative for lesions/malignancy, what else can it report on?

Answer 13

Organisms

Reactive cellular changes - inflammation, etc.

Question 14

What are the 2 types of Epithelial Cell Abnormalities identified on PAP?

Answer 14

• Squamous cell

- Glandular cell

Question 15

ASC-US

Answer 15

Atypical Squamous Cells of Undetermined Significance

Question 16

ASC-H

Answer 16

Atypical Squamous Cells that cannot exclude High grade

Question 17

LSIL and what it encompasses?

Answer 17

Low grade Squamous Intraepithelial Lesion

= encompasses mild dysplasia and CIN1

Question 18

HSIL and what it encompasses?

Answer 18

High grade Squamous Intraepithelial Lesion

= Encompasses moderate-to-severe dysplasia, CIS, CIN2 and CIN3

Question 19

Atypical Glandular cells may give rise to?

Answer 19

Adenocarcinoma

Question 20

If you are under 25 and ASC-US or LSIL comes back, what is the next step?

Answer 20

Repeat Cytology at 1 year

Question 21

If you are under 25, had ASC-US or LSIL, repeated cytology at 1 year and it came back ASC-US or LSIL again, what is the next step?

Answer 21

Repeat Cytology at 1 year

Question 22

If you are under 25, had ASC-US or LSIL, did cytology, had it again, did cytology and ASC-US came back for a 3rd time, what is next?

Answer 22

Colposcopy

Question 23

If you are under 25 and ASC-US or LSIL is present, you repeated your cytology 1 year later and ASC-H or HSIL came back, what is the next step?

Answer 23

Colposcopy

Question 24

What should be done with ASC-US?

Answer 24

• Repeat cytology at 1 year

- HPV testing

Question 25

If ASC-US was present and you repeated cytology at 1 year and got ASC or if HPV was (+), what is the next step?

Answer 25

Colposcopy

Question 26

What is the next step for LSIL with a (-) HPV?

Answer 26

Cotesting at 1 year

Question 27

What is the next step for LSIL with no HPV test?

Answer 27

Colposcopy

Question 28

What is the next step for LSIL with a (+) HPV?

Answer 28

Colposcopy

Question 29

What are the 2 options with HSIL?

Answer 29

Excision | Colposcopy

Question 30

What is the gold standard for Cervical Cancer diagnosis?

Answer 30

Colposcopy with biopsy

Question 31

With a Colposcopy, what do you apply to the cervix and then look for?

Answer 31

3% Acetic Acid applied | --> Large abnormal nuclei turn WHITE

Question 32

In the order of better to worse prognosis, what can be seen on Colposcopy?

Answer 32

``` Acetowhite changes Punctuations Mosaicism Abnormal vessels Mass ```

Question 33

What are 2 Ablative treatments?

Answer 33

Cryotherapy | Laser Ablation

Question 34

What are 2 Excisional Treatments?

Answer 34

Cold Knife Cone | LEEP

Question 35

Cold Knife Cone is an excisional procedure. When is it done?

Answer 35

(+) endocervical curettage

Question 36

LEEP is an excisional procedure. What does it stand for?

Answer 36

Loop Electrode Excisional Procedure

Question 37

If an Unsatisfactory Colposcopy or there is a discrepancy between the PAP and Biopsy is present, what should you do?

Answer 37

Excisional procedure - - Cold Knife Cone - - LEEP

Question 38

What are some risks of Excisional procedures?

Answer 38

Bleeding, infection | Cervical stenosis or incompetence --> pregnancy issues

Question 39

What are the symptoms of Cervical Cancer?

Answer 39

Postcoital bleeding (after sex) Watery vaginal bleeding Spotting

Question 40

What are the symptoms of Cervical Cancer?

Answer 40

Postcoital bleeding Watery bleeding Spotting

Question 41

How can you prevent Cervical Cancer?

Answer 41

- Use protection, decrease sexual partners - Regular exams and PAPs - VACCINE

Question 42

Vaccination with the HPV Vaccine can prevent Cervical Cancer. What is 1 called?

Answer 42

Gardasil

Question 43

Gardasil protects against high risk HPV strains to prevent cervical cancer. When and who is it recommended for?

Answer 43

9-26 = GIRLS AND BOYS | -- can still give up to 45

Question 44

Can you still receive the Gardasil vaccination after you have had an abnormal PAP?

Answer 44

Yes

Question 45

Is Gardasil safe in pregnancy?

Answer 45

No | -- safe in breast feeding though