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
how do you manage someone who is greater than 25 if they have ASC-US
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
LSIL with negative HPV test
what if they both come back negative
repeat cotesting in 1 year
OR colposcopy
cotest in 3 years
LSIL with no HPV test
LSIL with positive HPV test
what would you do?
colposcopy
HSIL what do you do ?
immediate loop electrosurgical excision or colposcopy to determine the grade
what is a colposcopy
looking at the cervix with a microscope: gold standard for diagnosis, treatment and planning
what is colposcope
binocular stereomicroscope with variable magnification
in a colposcopy the cervic is washed with?
3% acetic acid; this dehydrates the cell and large nuceli of abnormal cells turn white
acetowhite changes
in a colposcopy you must visualize ?
the entire SCJ (squamous columnar junction)
with a colposcopy what changes are you looking for?
acetowhite changes, punctations, mosiacism, abnormal vessels, masses ( this is in order of severity)
treatment options for cervical cancer
ablative and excisional
ablative cervical cancer treatments
cyrotherapy
laser ablation
excisional cervical cancer treatments
cold knife cone (CKC)
loop electrode excisional procedure (LEEP)
if the endocervical curettage is positive what exicisonal procedure should you do
cold knife cone
risks of excisional procuedures for cerivical cancer
cervical incompetence with second trimester pregnancy loss
PROM
cervical stenosis
bleeding/infection
precursor lesions for cervical carcinoma preceede invasive carcinoma by _ years
10
symptoms or cervical carcinoma
watery vaginal bleeding, post coital bleeding, intermittent bleeding
cervical carcinoma spreads by?
direct invasion and lymphatic spread
treatment of cervical cancer
brachytherapy, CKC (cold knife cone), hysterectomy
brachytherapy- internal radiation
how can we prevent cervical cancer?
sexual abstinence
barrier protection
regular exams
HPV vaccination
HPV vaccine injection series
first dose
second dose 2 months later
third dose 6 months from the first
can you get the HPV vaccine if you already have an abnormal pap
what about if youre pregnant
yes
no
gardasil is a _ strain vaccine
9
cervarix is?
HPV vaccine that protects against 16 and 18 it is only for girls and is no available in the US anymore
side effects of the HPV vaccine
syncope, dizziness, nausea, headache, injection site pains
