Pap Smear, Cervical Dysplasia, Cervical Cancer (Wootton) Flashcards
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.
1) Simple columnar
2) Stratified squamous
3) Squamocolumnar junction
Cervical cancer and CIN are caused by?
HPV
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?
1) 16,18, 31 and 45
2) 16 and 18
3) 6 and 11
What are common risk factors for cervical neoplasia?
1) Multiple sexual partners
2) Smoking
3) Organ transplant
4) DES exposure
5) High parity
What was developed by Dr. George Papanicolaou in 1928 as a screening tool for cervical cancer and CIN?
Pap smear
What populations should not have a pap smear done?
1) Under 21
2) After hysterectomy
What is the pap smear guideline for patients ages 21-29 that had an initial normal test?
Cytology alone every 3 years
What is the pap smear guideline for patients ages 30-65?
HPV and cytology co-testing every 5 years
What is the pap smear guideline for patients ages 65 and older?
No screening following adequate negative prior screening
Low grade squamous intraepithelial lesion correlates with?
High grade squamous intraepithelial lesion correlates with?
1) CIN 1
2) CIN 2, CIN 3, and Carcinoma in situ
Adenocarcinoma is associated with what type of cells?
Glandular cells
What is gold standard for diagnosis and treatment planning with low grade and high grade intraepithelial lesion findings?
Colposcopy with directed biopsy
With a colposcopy, the cervix is washed with a 3% acetic acid which dehydrates cell and large nuclei of abnormal cells turn what color?
White (acetowhite changes)
With a colposcopy, what findings are you looking for?
1) Acetowhite changes
2) Punctuations
3) Mosaicism
4) Abnormal vessels
5) Masses
What are some ablative (destroy cervical tissue) treatment options?
What are some excisional treatment options?
1) Cryotherapy and laser ablation
2) Cold knife cone and Loop electrode excisional procedure (LEEP)
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__.
1) Endocervical curettage
2) Colposcopy
3) Pap and biopsy (ie High grade pap and negative colposcopy)
What is there an increased risk of with excisional procedures?
Preterm premature rupture of membranes (PPROM)
91% of cervical cancer is caused by?
HPV
What type of cancer makes up 80% of cervical cancer cases?
What type makes up 15% of cases?
1) Squamous cell carcinomas
2) Adenocarcinoma
What symptoms point toward cervical cancer?
1) Watery vaginal bleeding
2) Postcoital bleeding
3) Intermittent spotting
How does cervical cancer spread?
Direct invasion and lymphatic spread
What are methods of prevention of cervical cancer?
1) Use of barrier protection
2) Vaccination with HPV vaccine
What is the injection series for the HPV vaccine?
1) First dose
2) Second dose 2 months later
3) Third dose 6 months from the first
Who is the HPV vaccine recommended for?
All girls and boys ages 9-26
Can the HPV vaccine be given to men and women ages 27-45?
Yes (October 5, 2018 FDA approved)
Can the vaccine be used in pregnant women?
Is it safe in breastfeeding?
1) No
2) Yes
Can you receive the HPV vaccine if you already had an abnormal pap?
Yes
The 4 strain Gardasil vaccine protects against?
HPV 6, 11, 16 and 18
The 9 strain Gardasil vaccine protects against?
HPV 6, 11, 16, 18, 31, 33, 45, 52 and 58
Cervarix which is no longer available in the US is FDA approved for what population?
It protects against?
1) Girls ages 9-25
2) HPV 16 and 18
What side effects are commonly seen with the HPV vaccine?
1) Dizziness
2) Headache
3) Injection site reactions (pain, swelling and redness)
