Pap Smear/Cervical Dysplasia/Cancer Flashcards
what are the two types of epithelium in the cervix
stratified non keratinizing - ecto cervix
columnar- endo cervix
_ _ _ is the site where greater than 90% of cervical neoplasias arise
squamocolumnar junction
does the squamocolumanar junction changes as we get older?
yes, aas we get older the SCJ will be closer to the endocervix
cervical cancer and cervical intraepitheilial neoplasia are caused by?
HPV
how many HPV types are there, how many affect the angiogenital tract and how many are associated with cancer/are high risk
100
30
15
what are the 4 types of HPV that cause 70% of cervical cancers
16,18,31,45
_ and _ hpv stains are associated with genital warts and low grade lesions
6 and 11
risk factors for cervical neoplasia ?
multiple sexual partners, smoking, immunosuppresion, sexually transmitted infections, DES, high parity
the pap smear was developed by?
george papnicolaou: in 1928
ASCCP pap app shows management based on 5 year risk of developing _
CIN 3
pap screening under 21
no screening
pap screening 21-29
cytology every 3 years
pap screening 30-65
HPV and cytology co testing every 5 years
pap screening 65 and over
no screening following adequate negative prior screening
do we pap screen after hysterectomy
no- but there are caveats; past cervical cancer
how are pap smears analyzed
with specimen type: either conventional or liquid based
and by specimen adequacy
what are the specimen adequacy categories
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
general categorizations regarding pap screen results
negative for intraepithelial lesion or malignancy
epithelial cell abnormality
other
if pap results come back “negative for intraepithelial lesion” what else could be seen on pap that we can treat?
other noneoplastic findings- inflammation, radiation, IUD
organisms- trichomonas, fungal organisms, BV
epithelial cell abanormalities on pap screen can be divided into what 6 categories for squamous cells
- atypical squamous cells of undetermined signifigance- ASC-US
- atypical squamous cells cannot exclude high grade - ASC-H
- low grade squamous intraepithelial lesion LSIL which means CIN1/HPV/mild dysplasia
- high grade squamous intraepithelial lesion HSIL) which means moderate and severe dyplasia CIS, CIN2, CIN 3
- Squamous Cell Carcinoma
glandular cell abanormalities on pap screen can be divided into what 2 categories
- atypical- endocervical, endometrial, glandular(NOS)
- adenocarcinoma- endocervical, endometrial, extrauterine, NOS
normal cervical changes progression to cervical cancer
normal - >LSIL-> HSIL-> cervical cancer
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?
repeat cytology in a year
repeat cytology again in the next year
colposcopy
after a ASC-H or HSIL in a **25 year old **what do you do?
colposcopy
