Study Guide for Cervical Condition

Question 1

Develop a teaching plan for risk reduction measures, other than HPV vaccination, for cervical cancer.

Answer 1

-age : early age at first intercourse (18 or younger)
- sexual behaviors: multiple partner increase the risk
- smoking: current or former smokers have app. 2-3 tiems the incidence of high grade cervical intraepithelial lesions or invasive cancer.
-immunosuppression: HIV AID or other (medications) increase persistence of HPV infection. The immune system plays an important role in destroying cancer cells and slowing their growth & spread.
-oral contraceptive: estrogenic effect of OCs prevent ectopy of cervix from receing into cervical canal, leaving the vulnerable area exposed. Moreover, OC users are less likely to use barrier protection, thereby increasing their risk of contracting HPV.
-high parity: 2.3 times greater risk to develop SCC
-Genetic disposition: mother/sisters who had cervical cancer are more likely to develop the disease.
-nutritional status: low fruit & veggies have been identified as potential contributing factors in development of cervical cancer. Low level of v.C and E, folate, and caroteinoid have linked to cervical cancer.
Diethylstilbestrol: clear cell adenocarcinoma of vagina and cerix
Infectious agents: HSV-2 and Chlamydia trachomatis infection are known to be associated with chronic inflammatory response and micro-ulceration of cervical epithelium.

Question 2

Create an HPV vaccination protocol for your practice indicating who should and should not receive the vaccine.

Answer 2

Gardasil: protects against HPV 6, 11,16, 18 (cause majority warts & cervical cancers). Not a live virus so it is ok for immunocompromised pt.
**male & female: age 9-26
last: 5 years
route: IM/3 shots @0, 2, 6 months
**regular screening still need because vaccine does not provide protection against all HPV types that cause cervical cancer.
Cervarix: protects against persistent infection of HPV 16 & 18
IM injection @ 0, 1, 6 months.

Question 3

Compare the advantages and disadvantages of conventional and liquid-based cervical cytology screening.

Answer 3

Conventional cervical cytology screening aka PAP Smear
Advantage: cheaper
Disadvantage: not obtaining sufficient endocervical cells for adequate laboratory cytologic evaluation; unavoidably leaving much of the cellular sample on the collection device when transferring the materials to the glass slide; and obscured detection of abnormal cells d/t the presence of blood, mucus, air-drying or other artifacts on the slide.
Liquid based cervical cystology screening
Advantage: more complete removal of cellular material by rinsing the sampling devices in a liquid medium. Cells for cytologic examination are removed from medium via filtering process that minimizes the presence of obscuring artifacts.
***sample can also be used to test for HPV DNA, Chlamydia, and gonorrhea this eliminate the need for 2nd visit for woman who has a cytologic abnormality that warrants HPV DNA testing.
Disadvantage: not more sensitive or more specific than PAP test for detecting high grade cervical intraepithelial neoplasia.
**higher cost

Question 4

A 38 year-old woman with Atypical Squamous Cells of Undetermined Significance (ASC-US), positive high risk HPV.

management ?
what you tell her?

Answer 4

1. Describe your management decision
   1) Repeat Cytology @ 6-12 months
   2) HPV DNA testing
2. What exactly would you say to her when you notified her of the results?
   ASC-US: squamous do not appear completely normal but is not possible to determine the cause of abnormal cells.

Question 5

A 32 year-old woman whose Pap is normal/negative and negative for high-risk HPV. She has had recommended screening in the past and has never had an abnormal Pap.

Describe your management decision

What exactly would you say to her when you notified her of the results?

Answer 5

30-65 years old recommendation : 
Pap (w/o HPV) every 3 years
(preferred by USPSTF) 
OR
Pap (w/ HPV) every 5 years 
(preferred by ACS/ASCCP/ASCP)

Question 6

A 22 year-old woman with Low-Grade Squamous Intraepithelial Lesion (LSIL).
management ?
what you tell her?

Answer 6

Describe your management decision
Colposcopic examination
What exactly would you say to her when you notified her of the results?
LSIL refers to cervical cancer precursor encompassing the following→papillomavirus, mild dysplasia, and cervical intraepithelial lesion (LSIL)

Question 7

A 63 year-old woman with Atypical Squamous Cells-Cannot Exclude High Grade (ASC-H) .

Answer 7

Describe your management decision
Colposcopic examination
What exactly would you say to her when you notified her of the results?
HSIL refers to cervical cancer precursor encompassing moderate and severe dysplasia, carcinoma in situ, and cervical intraepithelial neoplasias 2 and 3 (CIN2 and CIN3)

Question 8

A 38 year-old woman whose Pap is normal/negative but positive for high-risk HPV. Her Pap last year was also negative but was positive for high-risk HPV.

Answer 8

Describe your management decision
HPV HR test r/o type 16 or 18
What exactly would you say to her when you notified her of the results?
- Treating lesions to prevent the development of cancer.
STI prevention & provide guidelines for safer sexual practices
Counseling about HPV infection and cervical cancer.
Encourage to reduce their risk of HPV exposure by delaying onset of sexual activity, decreasing number of sexual partners, and eliminating tobacco products.
- Condom should be encouraged especially with new multiple and nonmonogamous partners

Question 9

A 27 year-old woman whose Pap is negative/normal.
Describe your management decision
What exactly would you say to her when you notified her of the results?

Answer 9

Women 21-29 y.o
Pap ever 3 years
DO NOT routinely test for HPV