Papsmear cytology and cervical/vaginal cytologic ds Flashcards
pap results show:
Negative for Intraepithelial Lesion or Malignancy
No Neoplasia
what does Negative for Intraepithelial Lesion or Malignancy
(No Neoplasia)
mean?
Normal Pap Smear
Reactive cellular changes with inflammation, cellular repair, changes associated with IUD, Bacterial Vaginosis, Trichomoniasis
management of negative for Intraepithelial Lesion or Malignancy
(No Neoplasia)
No HPV → Follow routine PAP screening
If > 25yrs & HPV + → 2 options:
Cytology & HPV testing in 12 months OR Genotype for HPV 16, 18
what are types of squamous cell abnormalities?
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
what does ASC-US mean?
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
tx of ASC-US if older than 25?
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
tx of ASC-US if 21-24 yo?
(includes LSIL) repeat pap in 1 yr or HPV test
tx of ASC-US if younger than 21
repeat pap in 1 yr
what does ASC-H mean?
higher chance of cancer than ASC-US
tx of ASC-H?
colposcopy; Allows for visualization of the cervix using magnification after applying dilute acetic acid for accentuation of lesions
what does LSIL mean?
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
tx of LSIL age 25-29?
Colposcopy with Biopsy
tx of LSIL > 30 yo?
HPV Negative → Repeat Cytology in 1 year
HPV Positive → Colposcopy with Biopsy
what does HSIL mean?
Includes CIN II, CIN III & Carcinoma in situ
*usually from presisten HPV infxn : P-16 positive
tx of HSIL?
colposcopy with Biopsy
types of glandular cell abnormalities?
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
management of all glandula cell abnormalities?
Colposcopy for all glandular cell abnormalities
Glandular abnormalities may be indicative of endometrial neoplasia
what is CIN?
cervical intraepithelial neoplasia
*precursor for cervical carcinoma
what is the transformation zone?
squamocolumnar junction of the cervix: HIGHEST RISK for malignancy
description of CIN I?
ellular changes seen with HPV
CIN I → MILD dysplasia → Contained to basal ⅓ of epithelium
describe CIN II
moderate dysplasia
Including ⅔ thickness of basal epithelium
describe CIN III?
SEVERE dysplasia → >⅔ -up to full thickness of basal epithelium
what is Carcinoma in situ?
full thickness of basal epithelium
has not invaded the basement membrane
Preinvasive Cancer
tx options for CIN I?
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
tx options for CIN 2&3?
excision or ablation
types of excision?
LEEP → Loop Electrical Excision Procedure
Cold Knife Cervical Colonization
ablation types?
Energy-assisted destruction of lesions via:
Cryocautery
Laser Cautery
Electrocautery
when to start screening for cervical cancer?
21 yo
when do you stop screening for cervical cancer?
65
how often are you screened?
age 21-29: every 3 yrs
> 30 yo: cotesting–> Pap test & HPV q5 years preferred
OR
Pap every 3 years
what HPV are most commonly associated with cervical carcinoma?
Especially 16, 18 (70%), 31 & 33, 45, 52 & 58
avg age of dx for cervical cancer?
45 yo
where are the MC Mets for cervical cancer
Vagina, Parametrium, Pelvic Lymph Nodes
RF for cervical ca?
HPV, early onset of sexual activity, increased # of partners, smoking, CIN, DES exposure (Diethylstilbestrol = Synthetic Estrogen used in OCPs), Immunosuppression, STIs
what are the 2 types of cervical cancer?
Squamous (90%)
Adenocarcinoma (10%) → Clear cell carcinoma linked with DES
sx of cervical ca?
POST-COITAL BLEEDING/SPOTTING → Most Common Sx
Metrorrhagia, Pelvic pain + Watery discharge
dx of cervical cancer
Colposcopy with Biopsy → Pap smear with cytology used for screening
what is stage 0 cervical cancer?
carcinoma in situ
how is stage 0 ca tx?
Local Treatment:
Excision → LEEP, COld Knife Conization → Preferred
Ablation → Cryotherapy, laser
TAH-BSO
stage 1a1 ca?
microinvasion
tx of microinvasion?
Surgery → Conization, TAH-BSO, XRT
tx of stage I, IIA?
TAH-BSO, XRT + Chemo Tx → Cisplatin
definition of Stage IIb-IVa?
II → Extends Locally Beyond Cervix
III → Lower ⅓ of vagina
IVa → Local METS → Bladder, Rectum
stage IIb-IVa
XRT + Chemo → Cisplatin + 5FU
IVb or recurrent?
Metastatic:
IVb → Distant METS
tx of metastatic?
chemo, palliative SRT
how can cervical ca be prevented?
gardasil
whatis the gardasil recommendation?
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
what is the gardasil schedule?
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
what are contraindications for gardasil?
Immunosuppressed, pregnant or lactating
