Women's Health/ Abnormal Pap Smear Results Flashcards
What type of infection is the biggest risk factor for developing cervical dysplasia and cancer?
HPV infection with high-risk serotypes
What are some other factors that place a woman at high risk for developing cervical cancer?
- early intercourse
- multiple sex partners
- history of sexually transmitted infections
- compromised immune system
- early childbearing
- oral contraceptive pills (OCP) use
- smoking
- intrauterine diethylstilbestrol (DES) exposure
Which HPV serotypes cause 70% of cases of cervical cancer?
16 and 18
Which HPV serotypes are considered “high-risk” for causing cervical cancer?
16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 69
The HPV serotypes 6 and 11 are not considered “high-risk” for the development of cervical dysplasia/cancer; however, are the cause of 90% of all genital warts (condyloma accuminata). Describe the physical appearance of these genital warts.
Single or multiple soft, fleshy lesions appearing in the anogenital area. Over time they may resolve, remain unchanged, or grow in size and number.
How can HPV warts be treated?
- Imiquimod cream
- podophyllin solution
- liquid nitrogen
- excision
Besides HPV infection, what factors place a patient at high risk for cervical cancer?
- HIV infection or other immune suppression
- history of intrauterine diethylstilbestrol (DES) exposur
- history of treatment for CIN II/III or cervical cancer.
Patients with these risk factors should have frequent cervical cancer screening.
All women who have undergone hysterectomy do not need Pap smears. True or false?
False. Only women who have had a hysterectomy with removal of the cervix for benign indications and who have no prior history of CIN II/III, or worse may discontinue routine Pap smears.
What is colposcopy?
A technique used to evaluate cervical dysplasia that involves a special microscope to visualize the cervix
What is the transformation zone?
The area between the old and new squamocolumnar junction, where squamous metaplasia commonly occurs
Why is it important to identify the transformation zone during a colposcopy procedure?
It is where most dysplastic lesions occur, and, therefore, a colposcopy is considered inadequate if the transformation zone is not visualized in its entirety.
Describe acetowhite lesions.
These are areas of epithelium that turn temporarily white when acetic acid is applied on the cervix. These areas are considered abnormal because acetic acid turns areas of high nuclear density white.
What are the visual differences between leukoplakia and acetowhite lesions?
Leukoplakia is also white but does not require acetic acid to be visualized. The lesions are also usually raised. Leukoplakia is a nonspecific finding but must be biopsied since it may be dysplasia or cancer.
Besides acetic acid, what other chemicals can be placed on the cervix during colposcopy for visualization of lesions?
Lugol or Schiller iodine solution (abnormal areas appear yellow)
What is the name given to abnormal capillaries that appear as fine or coarse dots often over acetowhite areas?
Punctations
A more severe abnormal vessel pattern which has a tiled appearance is called what?
Mosaicism
What procedures can be performed along with colposcopy?
Cervical biopsies and endometrial curettage
What is the significance of mucusfilled cysts on the cervix?
Nabothian cysts are a normal finding and do not require treatment
According to the American Society for Colposcopy and Cervical Pathology (ASCCP), what options are available for the management of atypical squamous cells of uncertain significance (ASC-US)?
- HPV test is positive: colposcopy
- HPV test is negative: repeat Pap in 12 months
- HPV testing not done: repeat Pap in 6 months and 12 months and perform colposcopy if either Pap is abnormal
According to ASCCP, how does the management of ASC-US (atypical squamous cells of uncertain significance) in adolescents differ? Why?
- ASC-US in this population should be followed up with annual cytologic testing. If the HPV testing was inadvertently performed, the results should not influence management.
- The prevalence of transient HPV infection is high while the prevalence of invasive cancer is low in women 20 years of age or younger. Therefore, HPV reflex testing does not need to be performed in this population.
What is the initial management of low-grade squamous intraepithelial lesion (LGSIL) and high grade squamous intraepithelial lesion (HGSIL)?
Colposcopy
How is cervical dysplasia treated?
Laser ablation, cryotherapy, loop electrosurgical excision procedure (LEEP), cervical conization
