The Pap Smear, Cervical Dysplasia, and Cancer Flashcards
Where do most of the neoplasias arise in the cervix?
-the SCJ
Which HPV types cause the majority of cancers?
-16, 18, 31, 45
Which HPV typse are associated with genital warts and with low grade lesions?
-6 and 11
If girls are under 21, should they get a pap smear?
-No!
how often should women 21-29 get paps?
-cytology alone every 3 years
women 30-65 paps?
-HPV and cytology cotesting every 5 years
If a woman is >65 and there is an adequate negative prior screening, does she need screening anymore?
-no
do women need a screening after hysterectomy?
-no
What is the system that interprets the pap smear?
-the Bethesda system
If a woman has atypical squamous cells of undetermined significance on cytology, what do we do?
- either repeat cytology or do HPV testing (preferred)
- if there’s something wrong, then do colposcopy
- if HPV negative, repeat every 3 yrs
if HPV is present, what do we do?
- colposcopy
- if LSIL with negative HPV test, then repeat cotesting @ 1 year
What can we do if a woman has HSIL?
- immediate loop electrosurgical excision
- or colposcopy (with endocervical assessment)
What is considered the gold standard for diagnosis and treatment planning for cervix stuff?
-colposcopy
What is colposcopy?
- -binocular stereomicroscope with variable magnification
- cervix washes with 3% acetic acid… dehydrates cells and large nuclei of abnormal cells turn white
What are the white abnormal cells on colposcopy called?
-Acetowhite changes
What kind of changes are we looking for at the SC junction on colposcopy?
- acetowhite changes
- punctuations
- mosaicism
- abnormal vessels
- masses
If there is a little yellowish bump on the cervix, what is that?
- nabothian cyst
- completely normal
If there is a woman who is found to have a high risk HPV and she wants the HPV vaccine, what do we tell her?
-kindly fuck off because you’re not getting it
What are the 2 ablative tx options?
- cryotherapy
- laser ablation
What are the two excisional tx options?
- cold knife cone (CKC)
- Loop electrode excisional procedure (LEEP)
When are excisional techniques done?
- when endocervical cureettage positive (need CKC)
- unsatisfactory colposcopy (no SCJ)
- substantial discrepancy between pap and biopsy
What kind of cancers are cervical cancers most of the time?
-squamous cell carcinomas
What are some symptoms of cervical cancer?
- water vaginal bleeding
- postcoital bleeding
- intermittent spotting
If there is cervical cancer with microinvasive disease, what is the tx?
-CKC or hysterectomy
If the cervical cancer is invasive, what do we do?
-radical hysterectomy with lymph node dissection
IF the cervical cancer has bulky disease, what do we do?
-radical hysterectomy with LN direction or radiation therapy and cisplatin based chemotherapy
If the cervical cancer is stage 11b or greater, what do we do?
-external beam radiation and concurrent cisplatin based chemotherapy
What are some ways that we can prevent cervical cancer?
- Abstinence
- use of barrier protection
- regular exams and pap smears
- Vaccination with the HPV vaccine
How does the HPV vaccine work?
- 3 injections
- 1st
- 2nd 2 months later
- 3rd 6 months from the first
Who is the HPV vaccination recommended for?
-all girls and boys ages 9-26
What are the 4 strains that Gardasil protects against?
-6, 11, 16, 18
What are some side effects of HPV vaccine?
- Dizziness
- nausea
- headache
- fever
- injectiion site rxns
