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Clin Med3: Womens Health > Cervical Cytology - waldron > Flashcards

Cervical Cytology - waldron Flashcards

1
Q

what is the second most common cancer in women in less-developed regions

A

cervical cancer

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2
Q

what are risk factors for cervical cancer

A

early onset of sexual activity
“multiple partners”; or partner partners
long term use of OCPs
Low socioeconomic status
nutritional deficiencies
immunosuppression
tobacco use
lack of HPV vaccination

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3
Q

When is cervical cancer most frequently diagnosed (age)

A

35-44yo
mean age: 50

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4
Q

when is the percentage of cervical cancer deaths highest (ages)

A

55-64yo
mean age: 59

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5
Q

What can improve survival of cervical cancer

A

early diagnosis and treatment

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6
Q

What are the types of cervical cancer

A

Squamous cell carcinomas
Adenocarcinomas

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7
Q

where are squamous cell carcinomas found

A

arise in squamous epithelial cells of the cervix

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8
Q

where are adenocarcinomas found

A

arise in glandular cells of the endocervix - much harder to identify with Pap

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9
Q

how can we reduce the risk

A

sexual education for males and females regarding risk
use of barrier contraceptives (condoms) are not fail safe
HPV vaccines for BOTH male and females

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10
Q

what are the benefits of cervical cancer screening

A

identifies premalignant lesion as well as invasive disease
identification, appropriate treatment and surveillance

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11
Q

what are the methods of cervical cancer screening

A

Pap test (cytology)
HPV testing for high risk

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12
Q

what is the area at the greatest risk for neoplasia

A

transformation zone (squamocolumnar junction)

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13
Q

what are the complications of cervical cancer screenings

A

ablative therapies can cause damage to cervix:
-cervical stenosis
-infertility
-cervical incompetence
-premature rupture of membranes, preterm birth, low birth weight infants, perinatal death

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14
Q

where are the cell samples obtained from for screenings

A

transformation zone AND endocervical canal

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15
Q

what are the main cancers caused by HPV?

A

cervical cancer
anal cancer
oropharyngeal cancers

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16
Q

what type of HPV accounts for 70+% of all cervical cancers

A

16, 18

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17
Q

what are the highest risk HPV types

A

16 and 18

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18
Q

what are the low risk types of HPV

A

6,11, 40,42,43,44,54,61,72,81

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19
Q

What are the FDA approved HPV vaccines

A

Cervarix (taken off market due to lack of demand)
Gardasil (taken off market due to lack of demand)
Gardasil 9

20
Q

who is 9-valent HPV vaccine approved for

A

females and males 9-45 yo
women and men who have not previously received an HPV vaccine series who are at risk

21
Q

when is the HPV vaccination more effective

A

ideally given during recommended ages 11-12yo, through 26 yo for females and 21 for males

22
Q

Who gets two doses of HPV vaccine

A

people who get first dose before their 15th birthday
second dose should be given 6-12 months after the first dose

23
Q

who gets 3 doses of HPV vaccne

A

people who get their first dose on or after their 15th birthday and people with certain immunocompromising conditions

24
Q

what is the squamocolumnar junction

A

where glandular cells from the endocervical canal meet squamous cells from vagina and ectocervix

25
Q

what is the tranformation zone

A

cells undergoing transformation from columnar/glandular to squamous are in a state of squamous metaplasia

26
Q

what are cells in metaplasia at risk of

A

vulnerable to mutagens like HPV

27
Q

what is a pap test more sensitive for

A

detecting squamous lesions or malignancy than adenocarcinoma or adneocarcinoma in situ

28
Q

what will help to minimize bleeding during sample collection

A

sampling ectocervix before the endocervix

29
Q

what is the conventional pap test

A

cells samples using brush and/or spatula, smeared directly on slide and fixed with chemical fixative
blood and secretions can easily obscure cell visualization

30
Q

what cannot be done with conventional pap test

A

HPV typing

31
Q

what is liquid based bytology/pap

A

most common medium in US now
cells sampled using brush - placed in solution, centrifuged, then plated
lubricant interferes but blood does not

32
Q

What are FDA approved Screening tests

A

ThinPrep
SurePath

33
Q

What does NILM stand for

A

Negative for intraepithelial lesion of malignancy

34
Q

what does a finding of reactive mean

A

inflammatory changes or radiation changes

35
Q

what does a finding of ‘presence of organisms’ mean

A

candida, trichomonas, bacterial, vagininosis, actinomyces (IUD wearers)

36
Q

What is SIL

A

squamous intraepithelial lesion: general term for abnormal growth of squamous cell on surface of the cervix (ASCUS)
two categories

37
Q

what are the two categories of SIL

A

Low grade SIL (LSIL): early changes in size, shape, and number of cells from surface of cervix
High-grade SIL (HSIL): large number of precancerous cells

38
Q

What are glandular cell abnormaliteis indicative for

A

need for colposcopy, endocervical curettage AND endometrial biopsy - cancer workup

regardless of HPV status

39
Q

how many FDA approved tests for high-risk HPV

A

4

40
Q

how many types of available HPV test

A

2

41
Q

when should initial cervical cancer screening start

A

at age of 21 - regardless of age of initiation of sexual activity

42
Q

what age groups of doing cytology only for screenings

A

21-30yo - Q3 years if normal

43
Q

when is a Pap plus HPV typing recommended

A

30-65 years

44
Q

what are the recommendations for patients with supracervical hysterectomy

A

continue screening appropriate to their age group and history

45
Q

when can you stop screening at 65 years

A

if:
adequate prior screening: 2 negative consecutive co-tests OR 3 negative pap tests in last 10 years with most recent tests in last 5 years

46
Q

What is a LEEP procedure

A

loop electrosurgical excision
excision of entire transformation zone with electrified sire loop

47
Q

What are histology findings of cancer screenings

A

Cervical intraepithelial neoplasia (CIN)
staged 1-3
invasive carcinoma

Clin Med3: Womens Health (13 decks)

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