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R2F > Pap Smear, Cervical Dysplasia, Cancer > Flashcards

Pap Smear, Cervical Dysplasia, Cancer Flashcards

1
Q

cervical cancer- how common?

A

-4th most common cancer

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2
Q

cervix- anaomy

A
  • columnar epit
  • stratified nonkeratinizing squamous epit
  • SCJ- where 90% of cervical neoplasia arises!!
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3
Q

HPV- types responsible for 70% of cervical cancer

A

-16, 18 (31, 45- most of the rest)

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4
Q

risk factors for cervical neoplasia

A
  • > 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
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5
Q

who needs a pap smear??- under 21

A

-no screening

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6
Q

who needs a pap smear??- 21-29

A

-cytology alone every 3 yrs

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7
Q

who needs a pap smear??- 30-65

A

-HPV and cytology testing every 5 yrs

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8
Q

who needs a pap smear??- 65 and older

A

-no screening following adequate neg prior screening

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9
Q

who needs a pap smear??- after hysterectomy

A

-no screening

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10
Q

Pap smear- 2001 Bethesda system

A
  • type- Conventional or liquid based
  • adequacy- satisfactory or unsatisfactory (list reason)
  • general categorization
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11
Q

Pap smear- 2001 Bethesda system- general categorization

A
  • neg for intraepit lesion or malignancy
  • epit cell abnormality
  • other- see interpretation/result
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12
Q

Interpretation- neg for intraepit lesion or malignancy

A
  • organisms
  • other non neoplastic findings:
  • reactive cellular changes- infl, radiation, IUD
  • glandular cells status post hysterectomy
  • atrophy
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13
Q

Interpretation- Epit Cell Abnormalities- squamous cell

A 
Atypical Squamous cells
-ASC-US (undetermined significance)
-ASC-H (cannot exclude high grade)
LSIL
HSIL
SCC
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14
Q

Interpretation- Epit Cell Abnormalities- glandular cells

A
  • Atypical- endocervical, endometrial, glandular

- Adenocarcinoma- endocervical, endometrial, extrauterine

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15
Q

ASC-US- management

A 
Repeat cytology (1 yr):
-if ASC- colposcopy
HPV testing:
-if HPV positive- colposcopy
-if HPV neg- repeat cotesting in 3 yrs
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16
Q

LSIL- management

A

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

17
Q

HSIL- management

A

-Immediate loop electrosurgical excision
OR
-colposcopy- No CIN2,3 or CIN2,3

18
Q

HPV- gold standard for dx

A

colposcopy with directed biopsy

19
Q

Colposcopy

A
  • 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)
20
Q

colposcopy- look for?

A
  • acetowhite changes
  • punctuations (red dots)
  • mosaicism
  • abnormal vessels
  • masses
21
Q

LSIL with + HPV test- do what?

A

colposcopy!!

22
Q

treatment

A
  • ablative (cant follow up- so never considered)
  • excisional:
  • cold knife cone- if EEC +
  • LEEP (loop electrode excisional procedure)- if EEC negative
23
Q

excisional tx- done when?

A
  • ECC + (needs cold knife cone)
  • unsatisfactory colposcopy (no SCJ)
  • discrepancy b/w pap and bx
24
Q

risks of excisional procedures

A
  • cervical incompetency- 2nd trimester pregnancy loss
  • PPROM (preterm premature rupture of membranes)
  • cervical stenosis
  • bleeding, infection- operative risks
25
Q

Cervical carcinoma

A
  • 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
26
Q

Cervical carcinoma- sx’s

A
  • watery vaginal bleeding
  • postcoital bleeding (after sex)
  • intermittent spotting
27
Q

Cervical carcinoma- management- microinvasive

A

-cold knife cone or hysterectomy

28
Q

Cervical carcinoma- management- invasive (stage 1A2)

A

-radical hysterectomy with LN dissection

29
Q

Cervical carcinoma- management- bulky dz (1b and 2a)

A

-radical hysterectomy with LN dissection or radiation tx and cisplatin based chemotx

30
Q

Cervical carcinoma- management- stage 2b and greater

A

-external beam radiation and concurrent cisplatin based chemotx

31
Q

prevention of cervical cancer

A
  • sexual abstinence/ limit number of partners
  • use barrier protection!!!
  • regular exams and pap smears
  • vaccination!!!
32
Q

HPV vaccine

A
  • 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!!!!
33
Q

Gardasil

A
  • 4 strain vaccine- 6, 11, 16, 18

- 9 strain- 31, 33, 45, 52, 58

34
Q

Cervarix

A
  • against 16 and 18

- no longer available in US!!

35
Q

HPV vaccine- SE’s

A
  • dizziness
  • HA
  • injection site rxns

R2F (18 decks)

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