Vulvar and Cervical Cancer 2

Question 1

Describe the guidelines for cervical cancer screening.

Answer 1

• 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

Question 2

What is the benchmark for risk for cervical cancer?

Answer 2

• 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

Question 3

What is the threshold for treating HPV?

Answer 3

• 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

Question 4

Describe the process of colposcopy.

Answer 4

• 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

Question 5

What are some important aspects to pay attention to when evaluating a colposcopy?

Answer 5

• 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