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
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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
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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
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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
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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
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