Pap Smear Management

Question 1

Management of ASC-H regardless of HPV status or age?

Answer 1

Colposcopy!

Question 2

Management of CIN3?

Answer 2

Always excisional procedure

Question 3

Management of AIS

Answer 3

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

Question 4

Management of HSIL?

Answer 4

Colposcopy

*Can proceed right to excision procedure if > 24 yo

Question 5

ASCUS, HPV Neg

Answer 5

Co-testing in 3 years

Question 6

LSIL, HPV Neg

Answer 6

Co-testing in 1 year

Question 7

LSIL or ASCUS w/ HPV POS

Answer 7

COLPOSCOPY

Question 8

ASCUS w/ HPV Unkown

Answer 8

Age 25-29 = co-testing in 3 years

Age 30+ = co-testing in 1 year

Question 9

LSIL w/ HPV Unknown

Answer 9

COLPOSCOPY

Question 10

HSIL > CIN 1

Answer 10

Age < 25: Colpo + Cytology at 1 year

Age > 25: Colpo + Co-testing at 1 year

Question 11

ASC-H > CIN 1

Answer 11

Age < 25: Cytology at 1 and 2 years

Age > 25: Co-testing at 1 and 2 years

Question 12

ASCUS or LSIL > CIN 1

Answer 12

Age < 25: Cytology at 1 year

Age > 25: Colpo + co-testing at 1 year

Question 13

Management of CIN 2

Answer 13

Typically excisional procedure but can do observation (especially if < 25)

If observing: Repeat colpo and co-testing in 6 and 12 months

Question 14

Management Atypical Glandular cells

Answer 14

Colposcopy w/ ECC

Endometrial sampling if Age > 35 or under 35 w/ risk factors (AUB, chronic anovulation, obesity)

Question 15

Management Atypical Endometrial cells

Answer 15

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

Question 16

When would you NOT excise CIN2?

Answer 16

If age 21-24 OR

Pt desires not to

If electing to “observe” repeat COLPO + CYTOLOGY at 6 and 12 months

Question 17

Most oncogenic HPV strain?

Answer 17

HPV 16

Question 18

Risk Factors for Cervical Cancer

Answer 18

HPV 16
HPV 18
Early age coitarche
Multiple partners
Absence of pap smears
Hx of STIs
cigarette smoking

Question 19

CKC (as compared to LEEP) puts you at higher risk for what?

Answer 19

PROM
Preterm Birth
Birth Weight < 2500 g

Question 20

Which HPV strain is most commonly associated with adenocarcinoma?

Answer 20

HPV 18 (50% of cases)

HPV 16 is responsible for 60% of SSC cases

Question 21

HPV E6 oncoprotein is responsible for affecting which genes?

Answer 21

p53

Question 22

What are pap smear guidelines based on?

Answer 22

Management based on present risk of CIN 3 or higher

Question 23

General pap smear screening guidelines?

Answer 23

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

Question 24

When is expedited excisional treatment ok?

Answer 24

If immediate risk of CIN3 is 25-60% or more

If > 60% expedited treatment preferred*

Question 25

Pap smear screening after hysterectomy for treatment of high grade cytology (CIN2/3/AIS)?

Answer 25

Annual screening for 3 years
After 3 negative annual screens, continue screening every 3 years for 25 years

Question 26

Management of abnormal pap smear in pregnancy?

Answer 26

If CIN2 or 3