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ENRP II > Pap Smear/Cervical Dysplasia/Cancer > Flashcards

Pap Smear/Cervical Dysplasia/Cancer Flashcards

1
Q

what are the two types of epithelium in the cervix

A

stratified non keratinizing - ecto cervix

columnar- endo cervix

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2
Q

_ _ _ is the site where greater than 90% of cervical neoplasias arise

A

squamocolumnar junction

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3
Q

does the squamocolumanar junction changes as we get older?

A

yes, aas we get older the SCJ will be closer to the endocervix

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4
Q

cervical cancer and cervical intraepitheilial neoplasia are caused by?

A

HPV

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5
Q

how many HPV types are there, how many affect the angiogenital tract and how many are associated with cancer/are high risk

A

100

30

15

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6
Q

what are the 4 types of HPV that cause 70% of cervical cancers

A

16,18,31,45

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7
Q

_ and _ hpv stains are associated with genital warts and low grade lesions

A

6 and 11

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8
Q

risk factors for cervical neoplasia ?

A

multiple sexual partners, smoking, immunosuppresion, sexually transmitted infections, DES, high parity

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9
Q

the pap smear was developed by?

A

george papnicolaou: in 1928

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10
Q

ASCCP pap app shows management based on 5 year risk of developing _

A

CIN 3

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11
Q

pap screening under 21

A

no screening

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12
Q

pap screening 21-29

A

cytology every 3 years

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13
Q

pap screening 30-65

A

HPV and cytology co testing every 5 years

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14
Q

pap screening 65 and over

A

no screening following adequate negative prior screening

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15
Q

do we pap screen after hysterectomy

A

no- but there are caveats; past cervical cancer

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16
Q

how are pap smears analyzed

A

with specimen type: either conventional or liquid based

and by specimen adequacy

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17
Q

what are the specimen adequacy categories

A

satisfactory for evaluation

unsatisfactory for evaluation- not enough cells

specimen rejected/not processes- not labeled

specimen processed and examined by unsatifactory for evaluation- WBC/RBCs

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18
Q

general categorizations regarding pap screen results

A

negative for intraepithelial lesion or malignancy

epithelial cell abnormality

other

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19
Q

if pap results come back “negative for intraepithelial lesion” what else could be seen on pap that we can treat?

A

other noneoplastic findings- inflammation, radiation, IUD

organisms- trichomonas, fungal organisms, BV

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20
Q

epithelial cell abanormalities on pap screen can be divided into what 6 categories for squamous cells

A
  1. atypical squamous cells of undetermined signifigance- ASC-US
  2. atypical squamous cells cannot exclude high grade - ASC-H
  3. low grade squamous intraepithelial lesion LSIL which means CIN1/HPV/mild dysplasia
  4. high grade squamous intraepithelial lesion HSIL) which means moderate and severe dyplasia CIS, CIN2, CIN 3
  5. Squamous Cell Carcinoma
21
Q

glandular cell abanormalities on pap screen can be divided into what 2 categories

A
  1. atypical- endocervical, endometrial, glandular(NOS)
  2. adenocarcinoma- endocervical, endometrial, extrauterine, NOS
22
Q

normal cervical changes progression to cervical cancer

A

normal - >LSIL-> HSIL-> cervical cancer

23
Q

after ASC-US (atypical squamous cell of undetermined signifgance or LSIL in a 25 year old, what do you do next?

if in the next year it comes back the same what do you do ?

if in the next year it comes back ASC-H what do you do?

A

repeat cytology in a year

repeat cytology again in the next year

colposcopy

24
Q

after a ASC-H or HSIL in a **25 year old **what do you do?

A

colposcopy

25
Q

how do you manage someone who is greater than 25 if they have ASC-US

A

repeat cytology with or without HPV testing in a year

if there is more ASC or HPV positive you should do a colposcopy

if HPV is negative repeat co-testing in 3 years

26
Q

LSIL with negative HPV test

what if they both come back negative

A

repeat cotesting in 1 year

OR colposcopy

cotest in 3 years

27
Q

LSIL with no HPV test

LSIL with positive HPV test

what would you do?

A

colposcopy

28
Q

HSIL what do you do ?

A

immediate loop electrosurgical excision or colposcopy to determine the grade

29
Q

what is a colposcopy

A

looking at the cervix with a microscope: gold standard for diagnosis, treatment and planning

30
Q

what is colposcope

A

binocular stereomicroscope with variable magnification

31
Q

in a colposcopy the cervic is washed with?

A

3% acetic acid; this dehydrates the cell and large nuceli of abnormal cells turn white

acetowhite changes

32
Q

in a colposcopy you must visualize ?

A

the entire SCJ (squamous columnar junction)

33
Q

with a colposcopy what changes are you looking for?

A

acetowhite changes, punctations, mosiacism, abnormal vessels, masses ( this is in order of severity)

34
Q

treatment options for cervical cancer

A

ablative and excisional

35
Q

ablative cervical cancer treatments

A

cyrotherapy

laser ablation

36
Q

excisional cervical cancer treatments

A

cold knife cone (CKC)

loop electrode excisional procedure (LEEP)

37
Q

if the endocervical curettage is positive what exicisonal procedure should you do

A

cold knife cone

38
Q

risks of excisional procuedures for cerivical cancer

A

cervical incompetence with second trimester pregnancy loss

PROM

cervical stenosis

bleeding/infection

39
Q

precursor lesions for cervical carcinoma preceede invasive carcinoma by _ years

A

10

40
Q

symptoms or cervical carcinoma

A

watery vaginal bleeding, post coital bleeding, intermittent bleeding

41
Q

cervical carcinoma spreads by?

A

direct invasion and lymphatic spread

42
Q

treatment of cervical cancer

A

brachytherapy, CKC (cold knife cone), hysterectomy

brachytherapy- internal radiation

43
Q

how can we prevent cervical cancer?

A

sexual abstinence

barrier protection

regular exams

HPV vaccination

44
Q

HPV vaccine injection series

A

first dose

second dose 2 months later

third dose 6 months from the first

45
Q

can you get the HPV vaccine if you already have an abnormal pap

what about if youre pregnant

A

yes

no

46
Q

gardasil is a _ strain vaccine

A

9

47
Q

cervarix is?

A

HPV vaccine that protects against 16 and 18 it is only for girls and is no available in the US anymore

48
Q

side effects of the HPV vaccine

A

syncope, dizziness, nausea, headache, injection site pains

ENRP II (25 decks)

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