cervical disorders Flashcards by Nayla Mansoor

What is a Nabothian cyst

Benign cyst that forms when columnar (glandular) epithelium is covered by squamous epithelium (retain glandular material)
Yellow or transluscent filling

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Hoe do you diagnose and treat a nabothian cyst

Usually found incidentally on speculum exam

excision not required

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What are cervical polyps

benign polyps, <3cm, likely 2/2 chronic inflammation of cervical canal

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Cervical polyps can cause

post-coital bleeding or abnormal uterine bleeding

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How do you treat cervical polyps

If symptomatic, polypectomy

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What is normal cervical histology

Ectocervix: stratified squamous
Transformation zone: squamo-columnar junction (metaplasia)
Endocervical canal: mucin producing columnar

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What does an adequate cervical sample include

endocervical tissue

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What is cervical ectropion

normal variation, endocervical canal becomes everted

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What is the pathophys of HPV

virus enters cervical epithelium through microlacerations (2/2 intercourse)- TZ is very susceptible to HPV
HPV infects basal layer and only local cells
Virus stays latent for mo-yrs (until host cant fight anymore, or, a trigger)
Mature basal epithelial cells travel away from BM, to surface

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Which strains of HPV cause CIN

HPV 16: SCC

HPV 18: adenocarcinoma (many have HSIL as well)

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What strains of HPV can block the protective apoptic process

HPV E6 and E7

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Low risk HPV strains are

6 and 11

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Nearly half of all HPV patients are (age)

15-24

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RF for HPV infection are

Multiple sexual partners!!!
Smoking 
immunosupresison 
early onset sex 
Hx STD 
long term OCP use (estrogen receptors on HPV gene) 
Hx VIN/VaIN

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What is the HPV vaccine

Gardasil 9- protects against 6, 11, 16, 18, 31, 33, 45, 52, 58
ONLY US option
*still need pap smear based on age guidelines

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How do you dose Gardasil 9

<15: 2 doses, 0 and 6-12 months

15+: 3 doses, 0, 1-2, and 6 months

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How do you perform a pap smear

Thin prep or Surepath

insert into cervix, rotate 180

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What is the HPV DNA test

Cervista, or Hybrid Capture high risk HPV

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At what ages do you perform PAP smear testing

21 y/o (no matter onset of sex) - 65 y/o, every 3 years
NO HPV testing 21-24
(these guidelines do not apply to high risk pops, ex. immunocompromised)

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When do you begin co-testing for HPV

30+ y/o, every 5 years

NOT indicated if s/p hysterectomy

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Why not screen for cervical cancer with PAP before 21?

It does NOT reduce the rate of cervical cancer

1% of cervical cancer occurs prior to 20 y/o
- No pap unless high risk!!

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Who don’t we screen for HPV in young women

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You acquire HPV shortly after intercourse, but almost all cases clear w/in 1-2 yrs WITHOUT neoplastic change
-early screening can lead to anxiety, higher expenses, and overuse of follow up procedures

What SHOULD adolescent encounters include

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contraceptive counseling
STI screening (urine sample, no speculum if ASx)
HPV vaccine education/admin
Safe sex practices

For women 21-29, screening includes

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Cytology alone q3 years

NO HPV testing

For women 30-64, screening includes

Cytology + HPV DNA testing q5 years or Cytology alone q3 years

What pts are high risk for developing cervical cancer (yearly PAP)

``` HIV + immunocompromised Hx cervical cancer Hx CIN 2/3 Exposure to DES from mom ```

How do you screen HIV + women

screen q6 months year of diagnosis screen q1 year after first year *start screening at whatever age the diagnosis is

When do you stop screening for cervical cancer (not high risk obvs)

``` at 65 if in the past 10 years: 3 consecutive negative cytology alone 2 consecutive negative Co-testing results Most recent test w/in 5 years NO Hx of CIN w/in 20 years ```

What screening should you do if a woman >65 y/o reports a new sexual partner

TRICK question; None! | don't resume screening even if she has a new partner

When does screening stop in a woman w/ a hysterectomy (w/ cervix removed)

at time of surgery, if for a benign disease and NO Hx of CIN 2 w/in 20 years -If you had a hysterectomy for a sketch reason, still need to swabvaginal cuff and wall

**What do you do if on speculum exam you note an ABNORMAL cervical lesion

BIOPSY!!!!!! any abnormal lesion needs to be biopsied, NOT pap smeared a PAP is screening tool. Biopsy is diagnostic!

What is ASC-US

Atypical Cells of Underetmined Significance | They dont look that bad, they are the least worrisome pathologic finding

What causes ASC-US, if not HPV

Chlamydia trachomatis Herpes simplex Vulvovaginal atrophy

What is LSIL

Low grade Squamous Intraepithelial Lesion

What is HSIL

High grade Squamous Intraepithelial Neoplasm | *Assume HPV is present!!*

Does HSIL with negative HPV mean you are in the clear

NO- it carried a 29% 5 year risk for CIN 3+ | That is why you need Colposcopy immediately for HSIL

What does a negative cytology with no endocervical cells indicate

You did not get an adequate sample, you only got EXOcervical cells

What does Unsatisfactory cytology indicate

insufficient squamous component; HPV test can be falsely negative

Persistently (+) HPV test (2x) is associated with

21% chance that CIN 2-3 will persist in 36 months

What is CIN I

Lesion involving lower 1/3 of epithelial lining | typically regresses in 12 months

What is CIN II

Lesion involving lower 2/3 | 43% regress, 35% persist

What is CIN III

Lesion involving >2/3 epithelial lining | 32% regress, 56% persist

Explain satisfactory vs unsatisfactory colposcopy results

Satis: completely visualize transformation zone Unsatis: incomplete visualization of transformation zone. Have to perform endocervical curettage

What is a colposcopy

apply 5% acetic acid magnified view of the cervix Biopsy epithelium that turns white (leukoplakia, ulceration, punctation, mosaicism, atypical vessels)

What is a LEEP

Loop Electrosurgical Excision Procedure (aka cauterizing); High electrical current rapid heating of tissue (steam envelope surrounds wire vaporizing adjacent tissue)- send tissue to patho

When is a LEEP contraindicated

if invasion is suspected glandular abnormality on PAP Patient is pregnant

LEEP has replaced

Laser surgery in the treatment if CIN

Follow up for LEEP includes

avoid heavy lifting, sex, douching, tampon or cream use for 4 weeks May have malodorous discharge for 2-3 wewks First menses after LEEP may be heavier 2/2 partially removing endocervical canal

Side effects of LEEP include

Bleeding Infection Cervical obliteration, incompetence, stenosis Pre-term delivery

What follow up testing is required after LEEP

Co-testing at 12 and 24 months If you have (+) margins after LEEP, repeat cytology and EEC at 4-6 months If you have persistent CIN2 after LEEP, repeat LEEP, or hysterectomy

Mean age of cervical cancer diagnosis is

48 years old

What are the types of cervical cancer

Squamous (MC HPV 16): prevalence falling. 3mm or less is microinvasive. >3 is invasive Adenocarcinoma (MC HPV 18): prevalence rising. endocervical, endometrioid, clear cell, adenoid cystic

How does cervical cancer present

Asymptomatic! **Abnormal vaginal bleeding (cervix is friable) post-coital bleeding unilateral pelvic pain with radiation to hip/thigh (mets) Vaginal discharge (watery, mucoid, purulent, malodorous)

cervical disorders Flashcards

(53 cards)