Pap Smear, Cervical Dysplasia, Cervical Cancer (Wootton)

Question 1

The upper cervix (endocervix) is lined by a __1__ epithelium that contains mucous-secreting cells.

In contrast, the lower cervix (ectocervix) is lined by a __2__ epithelium.

__3__ is the site where greater than 90% of cervical neoplasia arises.

Answer 1

1) Simple columnar
2) Stratified squamous
3) Squamocolumnar junction

Question 2

Cervical cancer and CIN are caused by?

Answer 2

HPV

Question 3

Why HPV types cause the majority of cancers?

Which ones are responsible for 70% of cervical cancers?

Which types are associated with genital warts and with low grade lesions?

Answer 3

1) 16,18, 31 and 45
2) 16 and 18
3) 6 and 11

Question 4

What are common risk factors for cervical neoplasia?

Answer 4

1) Multiple sexual partners
2) Smoking
3) Organ transplant
4) DES exposure
5) High parity

Question 5

What was developed by Dr. George Papanicolaou in 1928 as a screening tool for cervical cancer and CIN?

Answer 5

Pap smear

Question 6

What populations should not have a pap smear done?

Answer 6

1) Under 21

2) After hysterectomy

Question 7

What is the pap smear guideline for patients ages 21-29 that had an initial normal test?

Answer 7

Cytology alone every 3 years

Question 8

What is the pap smear guideline for patients ages 30-65?

Answer 8

HPV and cytology co-testing every 5 years

Question 9

What is the pap smear guideline for patients ages 65 and older?

Answer 9

No screening following adequate negative prior screening

Question 10

Low grade squamous intraepithelial lesion correlates with?

High grade squamous intraepithelial lesion correlates with?

Answer 10

1) CIN 1

2) CIN 2, CIN 3, and Carcinoma in situ

Question 11

Adenocarcinoma is associated with what type of cells?

Answer 11

Glandular cells

Question 12

What is gold standard for diagnosis and treatment planning with low grade and high grade intraepithelial lesion findings?

Answer 12

Colposcopy with directed biopsy

Question 13

With a colposcopy, the cervix is washed with a 3% acetic acid which dehydrates cell and large nuclei of abnormal cells turn what color?

Answer 13

White (acetowhite changes)

Question 14

With a colposcopy, what findings are you looking for?

Answer 14

1) Acetowhite changes
2) Punctuations
3) Mosaicism
4) Abnormal vessels
5) Masses

Question 15

What are some ablative (destroy cervical tissue) treatment options?

What are some excisional treatment options?

Answer 15

1) Cryotherapy and laser ablation

2) Cold knife cone and Loop electrode excisional procedure (LEEP)

Question 16

A cold knife cone excisional technique is done when __1__ is positive.

Excisional techniques are also done when there is unsatisfactory __2__ or if there is a substantial discrepancy between __3__ and __3__.

Answer 16

1) Endocervical curettage
2) Colposcopy
3) Pap and biopsy (ie High grade pap and negative colposcopy)

Question 17

What is there an increased risk of with excisional procedures?

Answer 17

Preterm premature rupture of membranes (PPROM)

Question 18

91% of cervical cancer is caused by?

Answer 18

HPV

Question 19

What type of cancer makes up 80% of cervical cancer cases?

What type makes up 15% of cases?

Answer 19

1) Squamous cell carcinomas

2) Adenocarcinoma

Question 20

What symptoms point toward cervical cancer?

Answer 20

1) Watery vaginal bleeding
2) Postcoital bleeding
3) Intermittent spotting

Question 21

How does cervical cancer spread?

Answer 21

Direct invasion and lymphatic spread

Question 22

What are methods of prevention of cervical cancer?

Answer 22

1) Use of barrier protection

2) Vaccination with HPV vaccine

Question 23

What is the injection series for the HPV vaccine?

Answer 23

1) First dose
2) Second dose 2 months later
3) Third dose 6 months from the first

Question 24

Who is the HPV vaccine recommended for?

Answer 24

All girls and boys ages 9-26

Question 25

Can the HPV vaccine be given to men and women ages 27-45?

Answer 25

Yes (October 5, 2018 FDA approved)

Question 26

Can the vaccine be used in pregnant women?

Is it safe in breastfeeding?

Answer 26

1) No

2) Yes

Question 27

Can you receive the HPV vaccine if you already had an abnormal pap?

Answer 27

Yes

Question 28

The 4 strain Gardasil vaccine protects against?

Answer 28

HPV 6, 11, 16 and 18

Question 29

The 9 strain Gardasil vaccine protects against?

Answer 29

HPV 6, 11, 16, 18, 31, 33, 45, 52 and 58

Question 30

Cervarix which is no longer available in the US is FDA approved for what population?

It protects against?

Answer 30

1) Girls ages 9-25

2) HPV 16 and 18

Question 31

What side effects are commonly seen with the HPV vaccine?

Answer 31

1) Dizziness
2) Headache
3) Injection site reactions (pain, swelling and redness)