Vulvar and Cervical Cancer 2 Flashcards
Apply risk benchmarking to contemporary pap smear/HPV results when presented with a clinical scenario.
1
Q
Describe the guidelines for cervical cancer screening.
A
- 21 years old - start screening
- 21-29 years old
- cytology only every 3 years
- 30-65 years old
- cotesting with cytology and HPV preferred every 5 years
- cytology only every 3 years is acceptable
-
>/= 65 years old
- can stop if prefiously adequate screening
- unless there was CIN 2 or more in the past
- stop screening 20 years after last abnormal one
- will still benefit from annual pelvic exams
- rest of life is previous cancer
-
Post-hysterectomy
- stop if no cervix and no histology more than CIN 2 in last 2 years
- no cervical cancer diagnosis ever
2
Q
What is the benchmark for risk for cervical cancer?
A
- Routine screening Q3 years if NILM
- Short interval screening in ASC-US
- For everything else, do immediate colposcopy (LSIL/LGSIL, HSIL/HGSIL, ASC-H, AGC)
- add on EMB for AGC
3
Q
What is the threshold for treating HPV?
A
- 5% risk of cervical cancer is the threshold
- 3 year follow-up acceptable if under this
- If above, will get immediate colposcopy
- ASC-US is the highest grade that will allow for delay
- if HPV positive, will want to do colposcopy
- Can consider LEEP directly if HGSIL, can skip colposcopy
4
Q
Describe the process of colposcopy.
A
- Low-power (3x-15x) binocular
- Evaluate Cervix/Vulva/Vagina
- Focus on Transformation Zone (TZ)
-
Acetic Acid (3-5%)
- Look for areas of acetowhite change
-
Lugol Iodine Solution
- Look for areas that do not absorb iodine
-
Satisfactory colposcopy
- Complete visualization of TZ
- Complete visualization of entire lesion
- Biopsy: Taken to confirm colposcopist impression
- Colposcopic Sensitivity to detect CIN 3 approx 70%
- Increased when 2 or more biopsies taken
- Did not matter level of training: NP, Generalist, Gyn Onc Fellow, Gyn Onc
5
Q
What are some important aspects to pay attention to when evaluating a colposcopy?
A
- Size/Extension
- ACW: bright vs dull
- Border: Sharp vs less defined
- **Vascular pattern: **
- vessels irregular in size/shape course/arrangement
- all vessels should arborize
- large vessel on cervix that don’t expect, is probably not normal