Cervical Cancer Screening

Question 1

What percentage of cervical cncer occurs in women who don’t get paps?

Answer 1

50%

Question 2

WHat percentage of cervical cancer occurs in women who had a false negative pap

Answer 2

30%

Question 3

When does cervical cancer risk peak?

Answer 3

late 30s

and then a second peak in the late 60s

Question 4

What is asc-us

Answer 4

atypical squamous cells of udnetermined significance

Question 5

What is LSIL

Answer 5

low grade squamous intra-epithelial neolasi

Question 6

what is HSIL

Answer 6

high grade squmous intrapeitlieal neoplasi

Question 7

WHat is ASC_H

Answer 7

atypical squamous cells of undetermiend significance can’t exclude high grade

Question 8

What is AGS-NOS

Answer 8

atrypical glandular cells - NOS

Question 9

what is AGS

Answer 9

atypical glandular cells - favor neoplasi

Question 10

What is AIS

Answer 10

adenocarcinoma in situ

Question 11

What are the grades in histology?

Answer 11

CIN 1, 2, 3 cervical intra-epithelial neoplasia
CIS - carcinoma in situ
AIS - adenocardinoma in situ

Question 12

What makes CIN 1? 2? 3? CIS?

Answer 12

1 - lower third
2 - into middle third
3 - into upper third, but not all the way up
CIS - all the way up to the top (haven’t invaded basement membrnae)

Question 13

What do you look for in a colposcopy?

Answer 13

you zoom in, spray vinegar on it, and look for acetowhite changes (thicker abnormal skin will pick up the vinegar)

then biopsy

Question 14

What’s between CIS and invasive cancer?

Answer 14

microinvasion - when you get a few cells under the GBM - measured in milimeters of depth (it’s a minute change)

Question 15

How is cervical cancer staged beyond microinvasion?

Answer 15

clinically - no matter what they find on biopsy or surgery, the staging stays the same.

Question 16

True or false: invasive cancer can be missed by a pap

Answer 16

true - but the clinical should see it

Question 17

What are the major oncogenic types of HPV?

Answer 17

16 and 18

followed by 31 and 33

Question 18

WHat are the cervical cancer high risk factors?

Answer 18

HIV
immunosuppressed
history of abnormal paps in prior 10 years
history of cervical cancer
history of CIN2/3/CIS
history of in utero DES exposure
partner who slept with someone else with cervical cancer

Question 19

At what age do we start paps now?

Answer 19

age 21 (regardless of when they started having sex)

Question 20

WHy was this change made if 50% of those under 21 will have it?

Answer 20

because 90% will resolve within 2 years

Question 21

CIN is very common in those under 21 as well. Why don’t we do anything about it right away?

Answer 21

usually regresses spontaneously

Question 22

At age 21-29, how often do you do paps?

Answer 22

every 3 years

Question 23

Is HPV testin recommended in age 21-29?

Answer 23

only if they have ASC-US on pap

Question 24

Age 30-65, when do you do pap?

Answer 24

every 3 years if alone

every 5 years if you do HPV testing with it

Question 25

Age over 65?

Answer 25

don't screen women who have had adequate prior screeing and are low risk even if they have a new sexual partner

Question 26

What is adequate prior screening?

Answer 26

3 consecutive negative cytology screenings at 3 year intervals within previous 20 years or 2 consecutive negative cotest within the previous 10 years

Question 27

What do you do in HIV positive patients?

Answer 27

screen at 6 month intervals until 2 pap tests are negative, then annual screening begin screening at time of diagnosis - regardless of age.

Question 28

What is the screening guideline following total hysterectom?

Answer 28

do not screen women who have undergone removal of the cervix and have no history of CIN2+ or cervical cancer but continue to screen if history of CIN/2/3/CIS, adenocarcinoma in-situ, or cancer

Question 29

So when is HPV testing appropriate?

Answer 29

``` iwth ASC-US postmenopausal women with LGSIL primary screen if over age 30 as an adjunct to cytology follow-up after treatment for CIN2 and 3 Follow-up after CIN1 if you'r eover 21 ```

Question 30

What types does gardasile protect against?

Answer 30

16, 18, 6, 11

Question 31

What's the typical age to give?

Answer 31

ages 9-26

Question 32

What does cervarix protect against?

Answer 32

16 and 18

Question 33

What is the advantage of the gardasil?

Answer 33

6 and 11 cause genital warts

Question 34

What is gardasil about to come out with?

Answer 34

gardasil 9, which will protect against 5 more high risk types not sure about people who have already had the old version

Question 35

Wahat do you do if the cytology is negative, but HPV is positive on cotesting?

Answer 35

just repeat co-testing in 1 year or do immediate genotype specific testing for HPV 16/18 if 16 or 18 - do colposcopy right away

Question 36

Women who have either spontaneous regression or appropriate treatment of CIN2 or higher should continue screening for how long?

Answer 36

at least 20 years, regardless of whether it takes them past 65 yrs