Pap Smear Management Flashcards
Management of ASC-H regardless of HPV status or age?
Colposcopy!
Management of CIN3?
Always excisional procedure
Management of AIS
Excision is ALWAYS needed to rule out invasive cancer!!!!
Pos margins = re exicision
Neg margins = benign hyst
If Neg margins + wants fertility = hyst after childbearing
If invasive cancer on excision = referral to onc
ASCUS, HPV Neg
Co-testing in 3 years
LSIL, HPV Neg
Co-testing in 1 year
LSIL or ASCUS w/ HPV POS
COLPOSCOPY
ASCUS w/ HPV Unkown
Age 25-29 = co-testing in 3 years
Age 30+ = co-testing in 1 year
LSIL w/ HPV Unknown
COLPOSCOPY
Management of CIN 2
Typically excisional procedure but can do observation (especially if < 25)
If observing: Repeat colpo and co-testing in 6 and 12 months
Management Atypical Glandular cells
Colposcopy w/ ECC
Endometrial sampling if Age > 35 or under 35 w/ risk factors (AUB, chronic anovulation, obesity)
Management Atypical Endometrial cells
Endometrial sampling w/ ECC recommended
Colposcopy can also be performed. Generally colposcopy should be performed, because if the other samplings are negative, colposcopy would then be warranted at that point
When would you NOT excise CIN2?
If age 21-24 OR
Pt desires not to
If electing to “observe” repeat COLPO + CYTOLOGY at 6 and 12 months
Most oncogenic HPV strain?
HPV 16
Risk Factors for Cervical Cancer
HPV 16
HPV 18
Early age coitarche
Multiple partners
Absence of pap smears
Hx of STIs
cigarette smoking
CKC (as compared to LEEP) puts you at higher risk for what?
PROM
Preterm Birth
Birth Weight < 2500 g
Which HPV strain is most commonly associated with adenocarcinoma?
HPV 18 (50% of cases)
HPV 16 is responsible for 60% of SSC cases
HPV E6 oncoprotein is responsible for affecting which genes?
p53
What are pap smear guidelines based on?
Management based on present risk of CIN 3 or higher
If >/= 4% colposcopy
If 25-60% colposcopy or treatment
If > 60% expidited treatment prefered
General pap smear screening guidelines?
No screening under 21
Age 21 start screening cytology Q3 yrs (no co-test)
Age 30-65 co-testing Q5 yrs
Discontinue screening age 65
When is expedited excisional treatment ok?
If immediate risk of CIN3 is 25-60% or more
If > 60% expedited treatment preferred*
Pap smear screening after hysterectomy for treatment of high grade cytology (CIN2/3/AIS)?
Annual screening for 3 years
After 3 negative annual screens, continue screening every 3 years for 25 years
Risk of a LEEP?
Cervical stenosis
Increased risk of SAB if < 12 month interval
Increased risk of second tri loss/PTB (~1%) but not great evidence
CIN2 risk of progression?
50% regress
30% stay CIN2
20% progress to CIN3+
Dosing for HPV vaccine?
Approved ages 9-46
If 9-15 get 2 doses (0, 6 months)
If > 15 then 3 doses (0, 2, 6 months)
HPV strains covered by HPV vaccine 9 valent?
6, 11, 16, 18, 31, 33, 45, 52, 58
