5. Pap Smear Flashcards
(26 cards)
Cervical cancer has decreased more than 50% over the last 30 years and is the 4th MC cancer. There are two type of epithelium: columnar and stratified NONkeratinizing squamous epithelia with what in between which is where 90% of neoplasia occurs?
Squamocolumnar Junction (SCJ)
What is between the new SCJ and the original SCJ?
Transformation zone
Cervical cancer and CIN are caused by HPV, there are 100 types and 30 affect anogenital tract, 15 are associated with cancer and are called high risk?
HPV types
What are the 4 HPV strains that cause most of the cervical cancers, with 2 making up 70%?
16 18 31 45
6/11 are genital warts w low grade lesions
Risk factors include multiple sex partners, smoking, HIV, organ transplant, Diethystilbestrol exposure (DES), high parity and lower?
socioeconomic status
PAP SMEAR: who needs it?
any one under 21 DOES NOT need screening
women aged 21-29 require what?
Cytology alone every 3 years
Women aged between 30-65 require what regarding HPV testing?
Cotesting = HPV and cytology every 5 years
No screening is required after a hysterectomy and also for what age group, in which there was adequate negative prior screening?
Age 65+
2001 Bethesda system is used for pap smears, general categorization of the specimen: negative for intraepithelial lesion or malignancy, epithelial cell abnormality: see result, other: see result, it also can show positive for what?
Organisms such as trichomonas, fungal, shift in flora (bacterial), actinomyces, and cellular change consistent with HSV
Other non neoplastic findings in 2001 bethesda system include inflammation, radiation, intrauterine contraceptive device, glandular cells pot hysterectomy and?
atrophy
What is the most common epithelial cell abnormality with 2001 bethesda systema, composed of atypical squamous cells of either 1) undetermined significance (ASC-US) or cannot exclude high grade (ASC-H), low grade intraepithelial, high grade (LSIL/HSIL)?
Squamous cell is MC epithelial cell abnl
Glandular cells can be atypical either endocervical, endometrial (neoplastic) or glandular (neoplastic), what epithelial cell abnormality can be found in endocervical, endometrial, extrauterine?
Adenocarcinoma
If a women has atypical Squamous cells of undetermined significance (ASC-US) on cytology and HPV testing is negative, when should repeat cotesting be done?
3 years
Women with low grade squamous intraepithelial lesion LSIL, with negative/positive/no HPV testing, what should be done?
Colposcopy
What are the two options for a women with high grade squamous intraepithelial lesions HSIL?
Either Colposcopy or Immediated loop electrosurgical excision
A colposcopy with directed biopsy is gold standard for dx and treatment planning, it is a binocular steromicroscope with magnification, cervix is washed with 3% acetic acid which dehydrates cell and large nuclei of abnormal cells and turns them?
White! = Acetowhite changes (AW)
A colposcopy must visualize the entire SCJ, looking for AW changes, punctuations, mosaicism, abdnormal vessels and masses (last two are worrisome)… What is the main difference between what a PAP and cytology/tissue gives you?
PAP: Intraepithelial lesions, ASC-US or ASC-H
Tissue: actual staging as carcinoma in situ or carcinoma
If acetowhite AW changes are present, there is probably a CIN 1, if punctuations are present, they are most common associated with?
CIN2/3
When mosaicism occurs it is bad, looks like red tiles within white, most likely a high grade lesions (CIN3), what is one charcteristic of cervical cancer that Dr. Wooton said?
It smells BAD
Treatment includes ablative including cryotherapy and laser ablation as well as excisional treatment with cold knife cone (CKC-apple core like)-done under anethesia, and what?
Loop electrode excisional procedure (LEEP) - done in office
There is an increased risk of cervical incompetence and resultant second trimester pregnancy lost, increased risk of preterm premature rupture of membrans PPROM, cervical stenosis and operative risks including infection and?
BLEEDING
Death rate from cervical carcinoma is 4% per year, usually 47, 91% of cancer is caused by HPV< 80% SCC, 15% adenocarcinoma… symptoms include watery vaginal bleeding, postcoital bleeding (after sex) and intermittent?
spotting
Cervical cancer is spread by either direct invasion or lymphatics and is staged clinically. if the cancer is invasive (Stage 1A/2) radical hysterctomy with LN dissection is good
NO_MEOW
Prevention of cervical cancer includes sexual abstinence/ limiting number of partners, protection, regular exams and pap smears, and most importantly?
VACCINATIONS with HPV VAX
