Pap Smear, Cervical Dysplasia, Cancer Flashcards
cervical cancer- how common?
-4th most common cancer
cervix- anaomy
- columnar epit
- stratified nonkeratinizing squamous epit
- SCJ- where 90% of cervical neoplasia arises!!
HPV- types responsible for 70% of cervical cancer
-16, 18 (31, 45- most of the rest)
risk factors for cervical neoplasia
- > 1 sexual partner, or a male sexual partner who has had sex with > 1 person
- young age at 1st intercourse
- Smoking
- HIV
- organ transplant
- STIs
- DES exposure
- infreq or absent pap screening tests
- high parity
- lower socioeconomic status
who needs a pap smear??- under 21
-no screening
who needs a pap smear??- 21-29
-cytology alone every 3 yrs
who needs a pap smear??- 30-65
-HPV and cytology testing every 5 yrs
who needs a pap smear??- 65 and older
-no screening following adequate neg prior screening
who needs a pap smear??- after hysterectomy
-no screening
Pap smear- 2001 Bethesda system
- type- Conventional or liquid based
- adequacy- satisfactory or unsatisfactory (list reason)
- general categorization
Pap smear- 2001 Bethesda system- general categorization
- neg for intraepit lesion or malignancy
- epit cell abnormality
- other- see interpretation/result
Interpretation- neg for intraepit lesion or malignancy
- organisms
- other non neoplastic findings:
- reactive cellular changes- infl, radiation, IUD
- glandular cells status post hysterectomy
- atrophy
Interpretation- Epit Cell Abnormalities- squamous cell
Atypical Squamous cells -ASC-US (undetermined significance) -ASC-H (cannot exclude high grade) LSIL HSIL SCC
Interpretation- Epit Cell Abnormalities- glandular cells
- Atypical- endocervical, endometrial, glandular
- Adenocarcinoma- endocervical, endometrial, extrauterine
ASC-US- management
Repeat cytology (1 yr): -if ASC- colposcopy HPV testing: -if HPV positive- colposcopy -if HPV neg- repeat cotesting in 3 yrs
LSIL- management
LSIL w/ neg HPV test:
-repeat cotesting (1 yr)- if ASC or HPV + test- colposcopy
LSIL w/ no HPV test: colposcopy
LSIL with + HPV test: colposcopy
HSIL- management
-Immediate loop electrosurgical excision
OR
-colposcopy- No CIN2,3 or CIN2,3
HPV- gold standard for dx
colposcopy with directed biopsy
Colposcopy
- colposcope- microscope with magnification
- cervix is washed with 3% acetic acid- large nuclei of abnormal cells turn white (acetowhite changes)
- must visualize entire SCJ!!
- directed bx and ECC (endocervical curettage)
colposcopy- look for?
- acetowhite changes
- punctuations (red dots)
- mosaicism
- abnormal vessels
- masses
LSIL with + HPV test- do what?
colposcopy!!
treatment
- ablative (cant follow up- so never considered)
- excisional:
- cold knife cone- if EEC +
- LEEP (loop electrode excisional procedure)- if EEC negative
excisional tx- done when?
- ECC + (needs cold knife cone)
- unsatisfactory colposcopy (no SCJ)
- discrepancy b/w pap and bx
risks of excisional procedures
- cervical incompetency- 2nd trimester pregnancy loss
- PPROM (preterm premature rupture of membranes)
- cervical stenosis
- bleeding, infection- operative risks
Cervical carcinoma
- precursor lesions precede invasive carcinoma by 10 yrs
- 91% caused by HPV
- SCC- 80%
- adenocarcinoma/adenosquamous- 15%
- spread by direct invasion and lymphatics
- staged clinically
Cervical carcinoma- sx’s
- watery vaginal bleeding
- postcoital bleeding (after sex)
- intermittent spotting
Cervical carcinoma- management- microinvasive
-cold knife cone or hysterectomy
Cervical carcinoma- management- invasive (stage 1A2)
-radical hysterectomy with LN dissection
Cervical carcinoma- management- bulky dz (1b and 2a)
-radical hysterectomy with LN dissection or radiation tx and cisplatin based chemotx
Cervical carcinoma- management- stage 2b and greater
-external beam radiation and concurrent cisplatin based chemotx
prevention of cervical cancer
- sexual abstinence/ limit number of partners
- use barrier protection!!!
- regular exams and pap smears
- vaccination!!!
HPV vaccine
- 3 injection series- 1st dose, 2nd dose 2 months later, 3rd dose 6 months from 1st
- or 2 dose series in < 15 yo
- recommended vaccination for all girls and boys ages 9-26!!!!
Gardasil
- 4 strain vaccine- 6, 11, 16, 18
- 9 strain- 31, 33, 45, 52, 58
Cervarix
- against 16 and 18
- no longer available in US!!
HPV vaccine- SE’s
- dizziness
- HA
- injection site rxns
