Test 3 Deck 2 Flashcards
When to screen for HPV?
> = 30, triage or surveillance of certain cytology abnormalities, post treatment surveillance
What are the ages for HPV vaccination?
9-26, but you can still give it afterwords
Cervical dysplasia screening for 21-29__, 30-65___, >65___, post hysterectomy __
21-29: PAP test q3
30-65: PAP w/ HPV testing q5 years, PAP alone q3 years
> 65: no hx of abnormal PAP and
- 3 neg. paps or
- 2 neg. co-tests in past 10 years w/ most recent test in past 5 years
Post hysterectomy:
- Retained cervix-> continue w/ age screening
- Cervix removed-> stopped screening
What do you do if you get a patient report that says atypical squamous cell of undetermined significance (ASC-US)?
Test for HPV
HPV + then treat like low grade squamous intraepithelial lesion -> colposcopy
HPV - then repeat PAP in 1 year and if still abnormal colposcopy
What do you do if you get if you have Atypical squamous cells, but can’t exclude HSIL (ASC-H)
Colposcopy indicated
What do you do if you get a report of High-Grade squamous intrepithelial lesion (CIN2 and CIN3)?
Colposcopy regardless of HPV and considers immediate loop electro surgical excision procedure (LEEP)
What is the treatment for atypical glandular cells and wha are you concerned for?
Colposcopy and endocervical sampling, women 35+ get endometrial sampling
Concern for cancers at other sites. endometrial/endocervical/ breast/ colon cancer
What to do with a woman that’s 21-24 w/ ASC-H, HSIL?
Colposcopy
What is the MC gynecologic cancer in women worldwide?
Cervical cancer caused by HPV, usually are aymptomatic
Tumor spread that arises from ectocervix
Exophytic
Tumor that arises from the endocervix??
Endophytic
What are the two kinds of cervical cancer spreads and which one is a poor prognostic factor?
Lymph node spread and lymphovascular spread (poor prognostic indicator)
What are the two most common types of cervical cancer and which is MC?
Squamous cell and adenocarcinoma
What is the MC cervical cancer and what has a.worse prognosis?
Squamous cell MC
Adenocarcinomas worse prognosis
PT presents w/ watery, purulent, or bloody discharge, They have polyploid mass, papillary tissue, barrel shaped cervix, a cervical ulceration, or granular mass, or necrotic tissue. They have an enlarged uterus, lymphadenopathy, hydronephrosis (tumor compressing ureter), lower back pain (sciatic), constipation, invasion of local tissues?
Cervical cancer
What is the follow up for cervical cancer?
Q 3 months for 2 years, then q 6 months until 5 years post-treatment then annually
Can you give hormone therapy during cervical cancer?
Yes, because the cancer is caused by a virus!
what are high estrogen states that cause the uterus to evert?
adolescence, pregnancy and hormonal birth control
where does almost all cervical neoplasia develop?
transition zone
what encourages increased metaplastic changes?
early age of 1st intercourse, and first pregnancy, vitamin deficiencies, COC
abnormal cells are confined to lower 1/3 of squmous epithelium
cervical intraepthelial neoplasia 1 CIN1
abnormal cells extending to the middle third, mixture of low and high grade
cervical intraepithelial neoplasia 2
abnormal cells extend to upper 3rd
cervical intraepithelial neoplasia 3
what is the mc sti in the US?
HPV
hpv causes nearly all __ neoplasia and a significant portion of __, ___, anal neoplasia
cervical, vulvar, vagina
what are the low risk HPV’s?
6, 11 associated w/ visible warts, laryngeal papillomas, subclinical HPV infections
high risk HPV lesions?
16, 18, 31, 33, 35, 45, 58 cause cervical CA development
what is the MC HR hpv?
16 followed by 18
type 16 causes what types of cancers?
anogenital and oropharyngeal, CIN 13, cervical
type 18 causes what kinds of cancers?
squamous cell, adenocarcinomas, adenosquamous carcinomas
HPV 16/18 lasting >6 months will develop into what?
squamous intrepithelial lesion
what is the MC abnormality for cervical dysplasia?
atypical squamous cells of undertermined significance (ASC-US)
what is considered LGSIL?
CIN1 and HPV infection
what do you do if you get a report that says LGSIL (low grade squamous intraepithleial lesion)?
no HPV or + HPV -> colposcopy
-HPV -> repeat cotest 1 year
pregnant woman w/ ASC-U and LSIL?
consider postponing until 6 weeks post partum, if you do coloposcopy no endocervical curette or EMB
pregnant woman w/ ASC-H?
don’t defer colposcopy
what do you do if the colposcopy is unsatifactory?
Loop electorsurgical excision procedure (LEEP) cold knife cone (CKC)
what will you see on coploscopy?
acetowhite (take biopsies) + endocervical curettage, green filter for abnormal vasculature
what do you do if you get an unsatisfactory cytology (not good enough)?
any age, HPV negative/positive
repeat cytology in 2-4 months
what is the MC gynecologic cancer in women worldwide?
cervical cancer
how to control abnormal bleeding associated w/ cervical cancer?
monsel paste
lymphadenopathy suggests?
spread
hydronephrosis suggests?
tumor compressing ureter
LBP suggests?
compression of sciatic nerve
cervical cancer in pregnancy treatment?
postpone if its early, but have to do something if advanced consider. cisplatin w/ vincristine, paclitaxel
