Pap and Cervical Cancer - Wootton Flashcards Preview

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Flashcards in Pap and Cervical Cancer - Wootton Deck (28):
1

90% of cervical neoplasia arises where?

SC junction - transformation zone

2

Major causes of cervical cancer

HPV 16, 18, 31, 45

3

Risk factors for cervical neoplasia

- Sex w/ multiple people
- Sex w/ cervical cancer person
- Smoking
- HIV
- Organ transplant
- STI
- DES
- Hx of it or high grade lesion
- Infrequent/absent paps

4

Only constant modifiable risk factor for cervical cancer

Smoking

5

***Pap smear frequency for...
- Under 21
- 21-29
- 30-65
- 65+
- Post-hysterectomy


Exceptions?

- None
- Cytology every 3 years
- HPV + cytology every 5 years
- None after adequate negative
- None

Previous positives, multiple sexual partners

6

19, G0, 1 sexual partner, smoker, depression, FHx of cervical cancer, FHx of diabetes...

Greatest risk for cervical cancer?

Pap smear?

Smoker

No (under 21)

7

40, AA, normal pap last year...

Next pap?

If HPV was unknown on last pap, when would she need next pap?

4 years (5 from negative)

4 years still

8

Which is better pap collection method: conventional of liquid-based?

Why?

Liquid based

Easier and can do while on period

9

Cervical biopsy comes back as positive for intraepithelial lesion (HPV). Now what?

Colposcopy --> acetic acid wash --> large nuclei of abnormal cells become white

10

Looking for what things on colposcopy of cervix? (in order of best to worst)

- Acetowhite changes
- Punctations
- Mosaicism
- Abnormal vessels
- Masses

11

Nabothian cyst - what is it?

Plugged mucus gland (like a zit) on the cervix - NORMAL

12

Abnormal vessels on cervix will look like what?

Straight, running perpendicular to Os

13

34, pap smear had low grade squamous intraepithelial lesion w/ positive high grade HPV. Next step?

Vaccine?

Biopsy (in 30s now)

Too late (to 26)

14

When do you treat the cervix?

CIN 2 or worse

15

Positive vs. negative endocervix -- treatments?

Positive -- Cold knife cone (CKC)

Negative -- LEEP (loop electrode excisional procedure)

16

Bad things about cryotherapy

- No margins to check after
- Lots of clear discharge after

17

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)

18

4 risks of doing excisional cervical procedures

- Risk of cervical incompetence (prolapse -- 2nd trimester loss)
- Risk of preterm premature rupture
- Cervical stenosis
- Bleeding/infection

19

Most cervical cancers are what?

HPV-caused SCC

20

A patient has a pap smear positive for high grade SIL. When might transformation to cancer occur?

10 years later

21

Watery vaginal bleeding, bleeding after intercourse, intermittent spotting, particular odor

Cervical cancer

22

Treatment of cervical cancer...
- Microinvasive
- 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

23

4 ways to prevent HPV/cancer

- Abstinence or small #
- Barrier protection
- Regular exams/paps
- HPV vaccine

24

Ages for HPV vaccine (Gardasil)

9-26 (boys and girls)

25

HPV vaccine - pregnancy?

NO, but ok in breastfeeding

26

A patient has an abnormal pap -- can they still get the HPV vaccine?

YES

27

Cervarix - for who?

Protects from what?

GIRLS 9-25

16 and 18

28

Side effects of HPV vaccine

Syncope, dizziness, nausea, headache, fever, injection site reactions