Cervical dysplasia Flashcards
(42 cards)
most cervical cancers are caused by
99.7% of cervical ca due to HPV infection
prognosis of cervical cancer and cell type
70% are squamous cell carcinoma (tend to be superficial, spread slowly, don’t tend to metastasize)
what % are adenocarcinoma
), 10-25% are adenocarcinoma (tend to behave more aggressively; in younger women; M&M related to this type)
mean age of cervical cancer diagnosis
Mean age at diagnosis 48 yrs
Risk Factors for cervical cancer
increased risks for HPV infection•
Early sexual activity
• High lifetime number of sexual partners
• Infection with HIV
• Smoking
• Long-term use of oral contraceptives (>5 years)
• Low socio-economic status
Protective Factors for cervical cancer
- Use of barrier contraception and spermicides
* High levels of vitamin C to boost your immune system to clear the infection
Screening Tools for cervical cancer
i. Pap smear
ii. HPV testing
iii. Colposcopy diagnostic tool for when someone has a positive screening test
cervical cancer screening recommendations
recommends screening for cervical cancer in women ages 21 to 65 years with cytology (Pap smear) every 3 years
OR
for women ages 30 to 65 years who want to lengthen the screening interval, screening with a combination of cytology and human papillomavirus (HPV) testing every 5 years.
the difference in cervical screening recommendations
for women over 30 there is a disagreement with co-testing
ACC and ACOG recommend preferred testing as co screening and the alternative is cytology every s yrs
PAP smear screens for
squamous cell carcinoma not as well as adenocarcinoma
w/ irregular bleeding or abnormal looking cervix you do need to go further
tools for pap
Cytobroom is all-in-one sampling tool
spatula can be used with cytobrush
i. Not a sterile exam
ii. Gown & drape patient
iii. Gloves
iv. Speculum
v. Cytobrush & collection kit
vi. Warm water or lubricant*
need to get cells from the squamocellurlar junction
things that may effect the pap
semen in the last 72 hours
use a Q tip to clean off the cervix first
sometimes if the pt recently had intercourse their cervix can be inflammed
not sex recently no period in the last 4 days ideally
results of pap
insufficient evidence
normal epithelial
low risk or high risk lesion
Most abnormal Pap results are
low-grade lesions in young women (<30 yrs), due to HPV infection
Majority of lesions regress spontaneously within 8-24 months
especially if patient is on vitamin C)
if PAP smears are abnormal
If abnormal Pap results (cytology) you want to know HPV status as a diagnostic tool
so either you order a reflex meaning if a pap is abnormal you get HPV test
Low-Risk Group (most common)
ASC-US
Atypical Squamous Cells of
Undetermined Significance
this can progress to–>
LSIL (higher grade lesion than ASC-US)
Low-grade Squamous Intraepithelial
Lesion (precancerous cells)
mngmt of LSIL
colposcopy
these cells are definitely dysplastic and have probably been around for a while
continued abnormality
High-Risk Group mngmt
requires colposcopy and biopsy
you need to know that this is anything outside of LSIL or ASC-US
ASC-US mngmt 21-24
repeat PAP in 12 mo
ASC-US mngmt >25
reflex testing
if NEG–> repeat PAP in 3 yrs
HPV positive –> colposcopy
LSIL and ASC-US in post menopausal women
often due to estrogen loss
low rate of HPV infection in this population
premarin 1gm in vagina qhs x3WKS then repeat 1 week after treatment
(1 month later)
HPV most oncogenic
16 and 18
low risk HPV
6 and 11 are low risk most commonly associated with gential warts
do not do HPV testing in
HIV positive or chemo
