Pap smear, Neoplasia, Cervical cancer – Flashcards

age 21, or 3 years from prev sexual intercourse, whichever younger 21-30, 1 yr apart 30-65, if normal for 3 years, then q3yrs if not, q1yr 65+ w/ normal for 3 years prior, can be off otherwise continue indefinitely anytime positive, repeat yrly, or further workup needed

atypical squamous cells of undetermined significance except ASC-US, everything else needs biopsy and colposcopy w/ ASC-US, it is important to test for *HPV DNA (16, 18, 30+ are cancerous)*; if low grade, repeat pap yrly

low-grade squamous cell intra-epithelial lesion "koilocytes" seen on biopsy

atypical squamous cells, cannot exclude high-grade SIL

high-grade squamous intra-epithelial leision if p16+ stain, pre-cancerous

atypical granular cells (adenocarcinoma)

HSIL w/ necrosis

CIN-I CIN-II CIN-III CIS invasive cervical cancer

pap 6-12 months OR HPV DNA at 12 months abnl - repeat colposcopy nml - annual Pap

surgical resection *LEEP* (loop electrical excision procedure) can cause incontinence conization, trachelectomy, hysterectomy

LSIL - resolve or progress. HSIL - resolve or become squamous cell cancer HPV DNA testing

stage? ask if she sees gyn? if yes does she get pap smear? if not DO IT!

if cancer spreads here, surgery will not be enough, and chemo/rad is needed

invade through basement membrane RFx: early intercourse, childbearing, HR partners, immuno, smoke, etc Sx: early = asymptomatic (post-coital bleed, watery, pain/pressure, rectal/urinary tract sx)

ONLY gyn cancer *staged clinically* w/ or w/out: `exam under anesthesia `cystoscopy `proctoscopy `IV pyelography `barium enema `CxR `MRI/CT (never on its own, only for meta) *stage 0*: `cervical carcinoma in situ *stage 1*: strictly confined to cervix `1a: microscopic lesion only `1b: gross lesions *stage 2*: spread beyond cervix, *but not the pelvic wall* `2a: no parametrial involvement `2b: parametrial involvement *stage 3*: spread to pelvic wall (3b), lower 1/3 of vagina, or caused hydronephrosis of a kidney *stage 4*: spread beyond pelvis or involves muscosa of the bladder/rectum

chemo is needed (parametrial involvement)

stage 0 and Ia(1): CKC or partial hysterectomy stage 1a(2) and 2a: radical hysterectomy or radiation stage 2b to 4: chemo-rad, surgery is often added ~stage 4: cisplatin and 5-fu recur or meta: + other med; radiation if never tried, pelvic exenteration (try a lot of things)

guard against intrathelial cancer? *vaccine against HPV* (recomb VLP; *all types*) rec *11-12 years boy/girl OVER 6 months! ask pt if they can come for all 3 in 6 months*. as early as 9yr, good until 26. it is annoying when parents say they don't want vaccine on their kids, allowing spreading of a disease that can be prevented due to false info (autism)