Pap Smear, Cervical Dysplasia, Cancer Flashcards

1
Q

Which strains of HPV cause the majority of cancers?

A

HPV 16, 18, 31, and 45

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2
Q

What are the risk factors for cervical neoplasia?

A
  • Multiple sexual partners
  • Young age at first intercourse
  • Smoking
  • HIV + Organ transplant
  • STI’s
  • DES exposure
  • High parity
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3
Q

What are the pap smear screening guidelines based on age?

A
  • Under 21 = no screening
  • 21-29 y/o = cytology alone every 3 years
  • 30-65 y/o = HPV and Cytology “cotesting” every 5 years (preferred)
  • 65+ y/o = no screening following adequate negative prior screening
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4
Q

What are the pap smear screening guidelines following hysterectomy?

A

No screening

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5
Q

If 40 y/o patient had an HPV status that was unknown on her last pap result when would she need another pap?

A

3 years when unknown

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6
Q

What can the 2001 Bethesda System tell us about a pap smear?

A
  • Specimen type
  • Specimen adequacy = satisfactory or unsatisfactory (not enough cells)
  • General categorization

- Organisms

  • Other non neoplastic findings: inflammation, radiation, IUD
  • Epithelial cell abnormalities
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7
Q

What are the guidelines for managment of a women w/ atypical squamous cells of undetermined significance (ASC-US) on cytology?

A

Repeat cytology at 1 year and do HPV testing

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8
Q

What are the guidelines for managment of a women w/ atypical squamous cells of undetermined significance (ASC-US) after repeat cytology at 1-year if result is negative or ≥ASC is found?

A
  • Negative: then back to routine screening
  • ASC: then do colposcopy
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9
Q

What are the guidelines for managment of a women w/ atypical squamous cells of undetermined significance (ASC-US) if HPV testing is positive vs. negative?

A
  • Positive = managed same as LSIL —> colposcopy
  • Negative = repeat cotesting at 3 years
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10
Q

What are the guidelines for managment of a women w/ LSIL and negative HPV test?

A
  • Repeat co-testing at 1 year (preferred), but colposcopy is acceptable
  • If cytology and HPV negative —> repeat at 3 years
  • If ≥ASC or HPV positive –> then colposcopy
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11
Q

What are the guidelines for managment of a women w/ LSIL and no HPV test or LSIL with a positive HPV test?

A

Colposcopy

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12
Q

What are the guidelines for managment of a women w/ HSIL?

A
  • Immediate loop electrosurgical excision

or

  • Colposcopy (w/ endocervical assessment)
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13
Q

What is the gold standard for diagnosis and treatment planning of abnormal pap smear?

A

Colposcopy w/ directed biopsy

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14
Q

What are the abnormalities you are looking for on Colposcopy?

A
  • Acetowhite changes
  • Punctuations (tiny blood vessels)
  • Mosaicism
  • Abnormal blood vessels
  • Masses
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15
Q

What are 3 instances when excisional techniques are done for cervical neoplasia?

A
  • Endocervical curettage positive (needs cold knife cone)
  • Unsatisfactory colposcopy (No SCJ)
  • Substantial discrepancy btw pap and biopsy (i.e., high grade pap and negative colposcopy)
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16
Q

What are the 2 ablative techniques for cervical neoplasia?

A
  • Cryotherapy
  • Laser ablation
17
Q

What are 4 risks associated with excisional procedures for cervical neoplasia?

A
  • ↑ risk of cervical incompetence and resultant 2nd trimester pregnancy loss
  • risk of preterm premature rupture of membranes (PPROM)
  • Cervical stenosis
  • Operative risks –> bleeding, infection…
18
Q

What are 3 signs/sx’s related to cervical carcinoma?

A
  • Watery vaginal bleeding
  • Postcoital bleeding
  • Intermittent spotting
19
Q

How is cervical carcinoma staged?

A
  • Clinically by:
  • PE
  • Radiologic exams –> CXR and skeletal XR’s + intravenous pyelogram
  • Cystoscopy
  • Sigmoidoscopy
  • Liver function studies
20
Q

How is microinvasive cervical carcinoma managed clinically?

A

Cold knife cone or hysterectomy

21
Q

How is invasive (early stages) cervical carcinoma managed clinically?

A

Radical hysterectomy w/ LN dissection

22
Q

How is bulky disease cervical carcinoma managed clinically?

A

Radical hysterectomy w/ LN direction or radiation therapy and cisplatin-based chemo

23
Q

How is stage IIb and greater cervical carcinoma managed clinically?

A

External beam radiation and concurrent cisplatin based chemotherapy

24
Q

What are the recommendations for the HPV vaccine?

A
  • All girls and boys ages 9-26 y/o
  • Approved for use in men and women 27-45 y/o
25
Q

How many injections are in a series of HPV vaccine and what is the recommendation for scheduling?

A
  • 3 injection series:
  • 1st dose
  • 2nd dose 2 months later
  • 3rd dose 6 months from the first (can still be given if interval varies)
  • In children <15 y/o give 2 doses separated by 6-12 month
26
Q

If a patient already has an abnormal pap can they receive an HPV vaccine; what about during pregnancy and breast feeding?

A
  • Can receive if already have abnormal pap
  • NOT for use in pregnancy, but safe in breastfeeding
27
Q

List 6 AE’s associated with HPV vaccination?

A
  • Syncope** (most common)
  • Dizziness + Nausea + HA + Fever
  • Injection site rxns (pain, swelling, and redness)