Flashcards in Pap and Cervical Cancer - Wootton Deck (28)
90% of cervical neoplasia arises where?
SC junction - transformation zone
Major causes of cervical cancer
HPV 16, 18, 31, 45
Risk factors for cervical neoplasia
- Sex w/ multiple people
- Sex w/ cervical cancer person
- Organ transplant
- Hx of it or high grade lesion
- Infrequent/absent paps
Only constant modifiable risk factor for cervical cancer
***Pap smear frequency for...
- Under 21
- Cytology every 3 years
- HPV + cytology every 5 years
- None after adequate negative
Previous positives, multiple sexual partners
19, G0, 1 sexual partner, smoker, depression, FHx of cervical cancer, FHx of diabetes...
Greatest risk for cervical cancer?
No (under 21)
40, AA, normal pap last year...
If HPV was unknown on last pap, when would she need next pap?
4 years (5 from negative)
4 years still
Which is better pap collection method: conventional of liquid-based?
Easier and can do while on period
Cervical biopsy comes back as positive for intraepithelial lesion (HPV). Now what?
Colposcopy --> acetic acid wash --> large nuclei of abnormal cells become white
Looking for what things on colposcopy of cervix? (in order of best to worst)
- Acetowhite changes
- Abnormal vessels
Nabothian cyst - what is it?
Plugged mucus gland (like a zit) on the cervix - NORMAL
Abnormal vessels on cervix will look like what?
Straight, running perpendicular to Os
34, pap smear had low grade squamous intraepithelial lesion w/ positive high grade HPV. Next step?
Biopsy (in 30s now)
Too late (to 26)
When do you treat the cervix?
CIN 2 or worse
Positive vs. negative endocervix -- treatments?
Positive -- Cold knife cone (CKC)
Negative -- LEEP (loop electrode excisional procedure)
Bad things about cryotherapy
- No margins to check after
- Lots of clear discharge after
3 times to do excisional biopsy of cervix
- Positive endocervical curettage (ECC)
- Unsatisfactory colposcopy (no SCJ)
- Big discrepancy between pap and biopsy (high grade pap vs. normal colp)
4 risks of doing excisional cervical procedures
- Risk of cervical incompetence (prolapse -- 2nd trimester loss)
- Risk of preterm premature rupture
- Cervical stenosis
Most cervical cancers are what?
A patient has a pap smear positive for high grade SIL. When might transformation to cancer occur?
10 years later
Watery vaginal bleeding, bleeding after intercourse, intermittent spotting, particular odor
Treatment of cervical cancer...
- Invasive (1a2)
- Bulky (1b, 2a)
- Stage 2b +
- CKC or hysterectomy
- Radial hysterectomy w/ LN dissection
- Radical hysterectomy w/ LN dissection, or radiation and cisplatin chemo
- External beam radiation and cisplatin chemo
4 ways to prevent HPV/cancer
- Abstinence or small #
- Barrier protection
- Regular exams/paps
- HPV vaccine
Ages for HPV vaccine (Gardasil)
9-26 (boys and girls)
HPV vaccine - pregnancy?
NO, but ok in breastfeeding
A patient has an abnormal pap -- can they still get the HPV vaccine?
Cervarix - for who?
Protects from what?
16 and 18