WH- Cervical/Uterine Flashcards
What age to start screening- Pap smear
age 21
Full pap smear includes
Cytology AND
HPV
Age 21-29 recommended screen includes
Only Cytology every 3 yrs
Age 30-64 screening recommends
Both types every 5 yrs
OR
Cytology every 3
OR
HPV every 5
Who is “high risk” and needs Cervical CA screening yearly?
HIV+ Immunocomp Hx of cervical CA Hx of CIN 2/3 Exposure to DES in utero
Can stop HPV/Pap at age 65 IF
3 cons negative Cytology tests 2 consecutive Co-test Has not had CIN2/3 in past 20 yrs Most recent pap was within 5 yrs Not high risk
If you are doing a Pap smear and see abnormal Cervical lesion, what should you do?
Ignore Pap and instead perform a BIOPSY
ASCUS pap result
“Atypical cells of undetermined significance”
If not HPV, d/t STD (chlamydia, HSV, or vulvovaginal atrophy)
If 21-24 YO, Do nothing, repeat Pap in 1 yr
LSIL pap result
“Low grade”
usually CIN 1
abundant cytoplastm
If 21-24 YO, Do nothing, repeat Pap in 1 yr
With ASCUS and LSIL pap results, if pt is 24-64 YO
Refer to guidlines
Get Colposcopy
HSIL pap results
“High grade”
Assume HPV is present
cells hyperchromatic nuclei, no cytoplasm
ALL REFER TO Colposcopy
What makes a Colposcopy sufficient?
If you have COMPLETE visualization of the Transition zone
Tx of choice for CIN 2 and 3
LEEP: Loop Electrosurgical Excision Procedure
CONTRA to LEEP procedure
Suspected invasion
Glandular abnormality
Pregnant
Nabothian cyst- Benign
Translucent/yellow
Glandular material is retained- columnar epith covered by Squamous epith
leave them alone, no tx required
Cervical polyp- Benign
Post coital bleeding
usually removed via Polypectomy bc they often become symptomatic
Layers of cervix
Exocervix: Squamous
Transitional zone: where the two meet, composed of Metaplastic squamous epithelium (rapid turnover)
Endocervix: columnar cells
Where does HPV prefer to hang out?
Transitional zone
HPV 16 is most assoc with what type of Cervical CA
Squamous cell
HPV 18 is most assoc with what type of Cervical CA
Adenocarcinoma
High risk for HPV
15-24YO
Multiple sex partners
the virus enters cervical epith thru microtears from intercourse
When to give Gardisil (HPV vaccine)
up to age 45
3rd most common GYN CA
Cervical CA
Mean age: 48 YO
Squamous cell cervical CA
HPV 16
Thankfully, prevalence is falling
Adenocarcinoma cervical CA
HPV 18
Bad news bears, prevalence is rising
Sx of cervical CA
often NONE
Abnormal vaginal bleeding if any
What is the only GYN CA that is CLINICALLY staged rather than based on Histology?
CERVICAL CA
Figo staging
What else do you need to consider ordering with Cervical CA?
CXR or CT to r/u Thoracic/chest METs
Made of collagen, smooth muscle, and elastin
surrounded by pseudocapsule
Uterine fibroids
Uterine fibroids are classified by location
Submucosal (beneath endometrium): often cause AUB and infertility
Subserosal
Intramural
Diagnostic choice for Uterine fibroids
Transvaginal US
These are 2-3x more common in African American women
Uterine fibroids
GnRH analog- Depot Lupron
to tx uterine fibroids
decreases fibroid size
good for near menopausal women
dont use longer than 6 mo
Steroidal (MIRENA) to treat uterine fibroids
NOT for submucosal
for long, heavy periods
Mirena, birth control, Nuvaring
Tarnexamic acid “Lysteda” to treat uterine fibroids
NOT for submucosal
for long heavy periods
use only during menses
this is an oral anti-fibrinolytic
What tx is ONLY for submucosal fibroids?
Hysteroscopy- preserves Fertility
heated loop resects fibroids
risk of fluid overload- monitor IandOs
Myomectomy for tx of fibroids
must have C section after this if you have future children
Endometrial ablation
Have to remove fibroids first b4 doing this to wall
for Menorrhagia (heavy period)
CANT HAVE KIDS after this
Uterine Artery Embolization (inject the embolizing agent via catheter)
CANT HAVE KIDS in future
only for Small fibroid
(CONTRA if large or many fibroids)
have to stay overnight: iv opioids post procedure
Adenomyoma
endometrial material grows INTO myometrium (uterus muscle)
Hx of previous uterine surgery should clue you into thinking about
Adenomyoma
How to make a definitive diagnosis of Adenomyoma?
Hysterectomy!!! need histology
Tx (also the diagnosis) of this Adenomyoma
Hysterectomy
Premenstrual pelvic pain, relieved by period
Endometriosis
Endometrial gland/stroma growth OUTSIDE of the endometrial cavity
Endometriosis
Why is Endometriosis more painful before period
Estrogen and Prog stimulate the growth of lesions, but limited by Fibrosis which causes pressure and inflammation
“Chocolate cysts” on ovaries
red, petechial lesions
thickness and scarring
Endometriosis
Laparoscopy is the only way to dx:
Endometriosis
Goal of tx for Endometriosis
STOP PERIOD to interrupt the stimulation of endometrial tissue
*Mirena (progestin) preferred Birth control Depot Excision Hysterectomy
Endometrial hyperplasia
Unopposed Estrogen
Risk factor for Endometrial hyperplasia
Obesity, obesity, obesity
Most common sx of Endometrial Hyperplasia
Bleeding changes
or
POST MENOPAUSAL bleeding
Tx for Endometrial Hyperplasia without Atypia
Rely on Prog hormone to help you
Mirena IUD
Provera
Tx for Endometrial Hyperplasia with ATypica
HYSTERECTOMY is tx of choice d/t increased risk of CA
if still want to have kids, high dose Progesterone
1 Most common GYN CA
Endometrial CA
Type 1 vs Type 2 of Endometrial CA
Type 1: d/t unopposed Estrogen, better prognosis
Type 2: seen w endometrial atrophy, poor prognosis
Type 1 Endometrial CA subtype
ADENOCARCINOMA is most common accounting for 80%
Endometrial CA (#1) is most common in what subtype of women
Caucasian
and Estrogen is a causative factor
If you see Lynch Syndrome/ HNPCC, you should perform Colaris screening to r/o
Endometrial CA
Tx for Endometrial CA
Hysterectomy w Bilateral salpingoophorectomy
Possible sx of Endometrial CA
AUB POST menopause bleeding Weight loss Dyspareunia Abd cramping Back pain
