The Pap Smear (1) Flashcards
Where does cervical CA ultimately arise from?
Squamo-columnar junction (SCJ)
What does HPV cause?
Cervical CA, genital warts (condyloma accuminatum), cervical intra-epi neoplasia (CIN)
Which HPVs are responsible for cervical CA? Genital warts?
16 and 18 for CA
6 and 11 for warts
What are risk factors for cervical neoplasia?
Multiple sexual partners Young age at first intercourse or preg Smoking HIV Organ transplants STIs DES exposure Infrequent/absent pap screenings High parity (many births) Low socioeconomic status
What are the screening guidelines for a Pap?
Under 21 = no screening
21-29 = every 3 years
30-65 = every 5
65+ = no screening following adequate neg prior screenings
Pts w/ hysterectomy: no screening afterwards
What the common Pap test done today?
Liquid-based
Does a mild Candida infection req tx?
No, if it’s normal flora can often let it go (unless it’s serious)
What are some non-neoplastic findings on a Pap?
Reactive cellular changes d/t (inlammation, radiation)
Atrophy (in elderly when E levels drop)
What does ASC-US and ASC-H stand for?
Atypical squamous cells
US = undetermined sig H = high-grade
When diagnosed w/ ASC-US, what are the next few steps of the treatment plan?
HPV testing
If positive > colposcopy
If neg, repeat testing in 3-5 years
Repeat cytology in 1 year to begin with is also acceptable, but not preferred
A pt is diagnosed w/ LSIL, what are the next steps in the tx plan?
Colposcopy if HPV presence is undetermined or positive
If HPV is neg, repeat testing in 1 year, then if ASC or HPV is found > colposcopy
What is the gold standard for diagnosis and treatment planning for cervical CA? What are you looking for?
Colposcopy
Large nuclei of abnormal cells w/ white “acetowhite” changes
Severity of abnormal colposcopy findings is:
Acetowhite changes < punctuations, mosaicism, abnormal vessels, masses
What biopsy technique is not used in pregnant women?
Endocervical curettage
Are Nabothian cysts benign or of concern?
Benign
What treatments are popular now for cervical pathology? Which aren’t?
Excisional
- cold knife cone (CKC)
- loop electrode excisional procedure (LEEP)
Ablative
- cryotherapy
- laser ablation
What are the risks of excision procedures?
Inc risk of cervical incompetence can lead to 2nd trimester pregnancy loss
Inc risk of PPROM (preterm premature rupture of membranes)
Cervical stenosis
Bleeding, infection
Cervical CA presentation is:
Watery vaginal bleeding, post-coital bleeding, intermittent spotting
What are ways to prevent cervical CA?
Sexual abstinence, barrier protection, regular exams, HPV vaccination
How does the HPV vaccine work? Can it be received after an abnormal pap? In pregnancy? Breastfeeding?
Three-injection series over the course of 6 months
Recommended for all girls and boys 9-26
Yes
No
Yes
What’s the name of the HPV vaccine? SEs?
Gardasil
Dizziness, HA, nausea, fever, injection site reaction
