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Womens Health > Papsmear cytology and cervical/vaginal cytologic ds > Flashcards

Papsmear cytology and cervical/vaginal cytologic ds Flashcards

1
Q

pap results show:

A

Negative for Intraepithelial Lesion or Malignancy

No Neoplasia

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2
Q

what does Negative for Intraepithelial Lesion or Malignancy
(No Neoplasia)
mean?

A

Normal Pap Smear
Reactive cellular changes with inflammation, cellular repair, changes associated with IUD, Bacterial Vaginosis, Trichomoniasis

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3
Q

management of negative for Intraepithelial Lesion or Malignancy
(No Neoplasia)

A

No HPV → Follow routine PAP screening

If > 25yrs & HPV + → 2 options:
Cytology & HPV testing in 12 months OR Genotype for HPV 16, 18

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4
Q

what are types of squamous cell abnormalities?

A

1) ASC-US: Atypical Squamous Cells of Undetermined Significance
2) ASC - H → Atypical Squamous Cells Can’t Exclude HSIL
3) LSIL → Low Grade Squamous Intraepithelial Lesion
4) HSIL → High Grade Squamous Intraepithelial Lesion

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5
Q

what does ASC-US mean?

A

May be due to multiple reasons → Main goal is to see if HPV related or not
70% of ASC-US regresses @ 24 months but HPV+ lesions have higher risk of progression to carcinoma

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6
Q

tx of ASC-US if older than 25?

A

HPV testing or repeat PAP:

HPV Negative → Repeat PAP & HPV cotesting in 3 yrs

HPV Positive → Colposcopy with Biopsy

Repeat PAP in 1 yr → If negative resume PAP screening
Colposcopy if positive

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7
Q

tx of ASC-US if 21-24 yo?

A

(includes LSIL) repeat pap in 1 yr or HPV test

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8
Q

tx of ASC-US if younger than 21

A

repeat pap in 1 yr

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9
Q

what does ASC-H mean?

A

higher chance of cancer than ASC-US

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10
Q

tx of ASC-H?

A

colposcopy; Allows for visualization of the cervix using magnification after applying dilute acetic acid for accentuation of lesions

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11
Q

what does LSIL mean?

A

Most commonly associated w/ cellular changes seen w/ transient HPV infxn

Includes CIN I

50% regress in 24 mos → May progress to cancer in 7 years

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12
Q

tx of LSIL age 25-29?

A

Colposcopy with Biopsy

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13
Q

tx of LSIL > 30 yo?

A

HPV Negative → Repeat Cytology in 1 year

HPV Positive → Colposcopy with Biopsy

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14
Q

what does HSIL mean?

A

Includes CIN II, CIN III & Carcinoma in situ

*usually from presisten HPV infxn : P-16 positive

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15
Q

tx of HSIL?

A

colposcopy with Biopsy

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16
Q

types of glandular cell abnormalities?

A

1) atypical
2) atypical glandular cells favor neoplastic (Features suggestive but not sufficient for diagnosis of adenocarcinoma)
3) endocervial carcinoma in situ/adenocarcinoma/ endometrial cells

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17
Q

management of all glandula cell abnormalities?

A

Colposcopy for all glandular cell abnormalities

Glandular abnormalities may be indicative of endometrial neoplasia

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18
Q

what is CIN?

A

cervical intraepithelial neoplasia

*precursor for cervical carcinoma

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19
Q

what is the transformation zone?

A

squamocolumnar junction of the cervix: HIGHEST RISK for malignancy

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20
Q

description of CIN I?

A

ellular changes seen with HPV

CIN I → MILD dysplasia → Contained to basal ⅓ of epithelium

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21
Q

describe CIN II

A

moderate dysplasia

Including ⅔ thickness of basal epithelium

22
Q

describe CIN III?

A

SEVERE dysplasia → >⅔ -up to full thickness of basal epithelium

23
Q

what is Carcinoma in situ?

A

full thickness of basal epithelium

has not invaded the basement membrane

Preinvasive Cancer

24
Q

tx options for CIN I?

A

observation: 75% resolve by immune system within 1 year
May be option if < 20 yrs

Excision:
LEEP → Loop Electrical Excision Procedure
Cold Knife Cervical Conization
+ Ablation

25
Q

tx options for CIN 2&3?

A

excision or ablation

26
Q

types of excision?

A

LEEP → Loop Electrical Excision Procedure

Cold Knife Cervical Colonization

27
Q

ablation types?

A

Energy-assisted destruction of lesions via:

Cryocautery
Laser Cautery
Electrocautery

28
Q

when to start screening for cervical cancer?

A

21 yo

29
Q

when do you stop screening for cervical cancer?

A

65

30
Q

how often are you screened?

A

age 21-29: every 3 yrs

> 30 yo: cotesting–> Pap test & HPV q5 years preferred
OR
Pap every 3 years

31
Q

what HPV are most commonly associated with cervical carcinoma?

A

Especially 16, 18 (70%), 31 & 33, 45, 52 & 58

32
Q

avg age of dx for cervical cancer?

A

45 yo

33
Q

where are the MC Mets for cervical cancer

A

Vagina, Parametrium, Pelvic Lymph Nodes

34
Q

RF for cervical ca?

A

HPV, early onset of sexual activity, increased # of partners, smoking, CIN, DES exposure (Diethylstilbestrol = Synthetic Estrogen used in OCPs), Immunosuppression, STIs

35
Q

what are the 2 types of cervical cancer?

A

Squamous (90%)

Adenocarcinoma (10%) → Clear cell carcinoma linked with DES

36
Q

sx of cervical ca?

A

POST-COITAL BLEEDING/SPOTTING → Most Common Sx

Metrorrhagia, Pelvic pain + Watery discharge

37
Q

dx of cervical cancer

A

Colposcopy with Biopsy → Pap smear with cytology used for screening

38
Q

what is stage 0 cervical cancer?

A

carcinoma in situ

39
Q

how is stage 0 ca tx?

A

Local Treatment:
Excision → LEEP, COld Knife Conization → Preferred
Ablation → Cryotherapy, laser
TAH-BSO

40
Q

stage 1a1 ca?

A

microinvasion

41
Q

tx of microinvasion?

A

Surgery → Conization, TAH-BSO, XRT

42
Q

tx of stage I, IIA?

A

TAH-BSO, XRT + Chemo Tx → Cisplatin

43
Q

definition of Stage IIb-IVa?

A

II → Extends Locally Beyond Cervix

III → Lower ⅓ of vagina

IVa → Local METS → Bladder, Rectum

44
Q

stage IIb-IVa

A

XRT + Chemo → Cisplatin + 5FU

45
Q

IVb or recurrent?

A

Metastatic:

IVb → Distant METS

46
Q

tx of metastatic?

A

chemo, palliative SRT

47
Q

how can cervical ca be prevented?

A

gardasil

48
Q

whatis the gardasil recommendation?

A

Recommendations → Given at age 11 up to 26 years of age → 2 types
Gardasil → Quadrivalent HPV Vaccine that targets HPV 6, 11, 16, 18
Gardasil 9 → Targets the same as Gardasil as well as HPV types 31, 33, 45, 52 & 58

49
Q

what is the gardasil schedule?

A

Individual < 15 yrs should receive 2 doses of HPV vaccine at least 6 months apart
> 15 yrs should receive 3 doses over a minimum of 6 months → Classically administered at day 0, 2 months and 6 months
Minimum interval between 1st 2 doses = 4 wks
Minimum interval between 2nd and 3rd doses = 12 wks

50
Q

what are contraindications for gardasil?

A

Immunosuppressed, pregnant or lactating

Womens Health (24 decks)

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