Vulvar and Cervical Cancer 1

Question 1

What are some important features of the HPV virus? DNA or RNA? Enveloped?

Answer 1

• Circular dsDNA
• 8kbp, 8-9 ORF
• Non-enveloped
• Icosahedral capsid

Question 2

What are the criteria that make the pap smear a succsessful tool for cervical cancer?

Answer 2

• Liquid-based
  
  • sensitivity > 95%
  • allows for reflex testing
    
    • HPV
    • gonorrhea
    • chlamydia

Question 3

What doe the following terms mean? NILM, ASC-US, LSIL, HSIL, ASC-H, AGC?

Answer 3

• NILM = No INtraepithelial Lesions or Malignancy
• ASC-US = Atypical Squamous Cells of Unknown Significance
• LSIL = Low-Grade Squamous Intraepithelial Neoplasia
• HSIL = High-Grade Squamous Intraepithelial Neoplasia
• ASC-H = Atypical Squamous Cells-Cannot exclude High-Grade Lesion
• AGC = Atypical Glandular Cells

Question 4

What is the use of HPV testing?

Answer 4

• Compared to cytology
  
  • greater sensitivity for CIN2,3
  • better reproducibility
• Diagnostic uses
  
  • triage of ASCUS Pap
  • triage of menopausal LGSIL
  • post-treatment screening
    
    • most clear HPV >/= 6 months LEEP
• Co-testing - HPV testing plus cytology
  
  • increased detection of CIN 3
  • similar Cx CA rates testing Q5 yrs vs. to cytology alone Q3 yrs
  • enhances detection of adenocarcinoma