Wells 11-13-07 Pap Smears

Front 1

3rd most common reproductive tract cancer.

Back 1

cervical cancer

Front 2

A pap smear is a
a) screening tool
b) diagnositic tool

Back 2

a) screening tool

Front 3

The point where the columnar cells meet the squamous cells is called the Original ______ Zone.

Back 3

Transformation

Front 4

Where is the Original Transformation Zone

Back 4

endocervical canal.

Front 5

What happens to the original squamocolumnar junction at menopause?

Back 5

it goes back into the opening of the cervix

Front 6

By the 11th week of gestation, stratified squamous cell partially replace the ____ cells.

Back 6

columnar

Front 7

By ___ weeks a cervix is recognizable

Back 7

16

Front 8

A single layer of ______ cells line the endocervical canal

Back 8

tall columnar

Front 9

Pathologists refer to cells lining the endocervical canal as _____ cells

Back 9

glandular

Front 10

At reproductive age the SCJ moves out of the endocervical canal, exposing the columnar surface to the acidic vagina and columnar cells are replaced by _______ cells.

Back 10

squamous

Front 11

Scrape the surface of the ectocervix and a portion of the _______ (transformation zone).

Back 11

endocervix

Front 12

Risk factors for cervical cancer include:

Back 12

1. Early age at coitarche.
2. Multiple lifetime partners.
3. Cigarette smoking.
4. Male partner that has had multiple partners.
5. Immunological compromise.
6. HPV Types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58
7. STD’s
8. Previous history of CIN.

Front 13

How is a normal pap reported?

Back 13

Negative for intraepithelial lesions or malignancy. (normal PAP).

Front 14

Bad Pap reports. Name them

Back 14

Atypical Squamous Cells of Undetermined Significance (ASC-US).
ASC-H cannot exclude high grade.
Low grade Squamous Intraepithelial Lesion (LSIL).
High grade Squamous Intraepithelial Lesion (HSIL).
Squamous cell carcinoma.
Atypical Glandular Cells (AGS)
Atypical Glandular Cells favor neoplastic.
Endocervical adenocarcinoma in situ (AIS).
Adenocarcinoma.

Front 15

If you get ASC-US, what do you do next?

Back 15

HPV typing

Front 16

If you get any report other than normal or ASC-US, what do you do?

Back 16

colposcopy

Front 17

things that can cause the ASC-US result

Back 17

recent douching, intercourse, infection

Front 18

Squamous intraepithelial abnormalities AKA

Back 18

(dysplasia)

Front 19

dysplasia is associated with what virus?

Back 19

HPV

Front 20

Basal cell proliferation extends through how much of the surface

Back 20

1/3rd

Front 21

Define Moderate dysplasia

Back 21

through 2/3 of the surface

Front 22

Define severe dysplasia

Back 22

through entire surface and does not disrupt the basal layer.

Front 23

Pap smears are a screening tool for cervical cancer.
They are ____% accurate

Back 23

85

Front 24

When do you start getting pap smears

Back 24

Begin screening 3 yrs. after the onset of vaginal intercourse ( coitarche) and no later than 21yrs

Front 25

Women treated for preinvasive squamous and glandular lesions have a 5 year survival rate of ____%.

Back 25

100

Front 26

What circumstances require more screening?

Back 26

HIV
Immunosupressed
DES exposure

Front 27

No need to do HPV DNA typing in patients with the following PAP test results:

Back 27

LSIL
HSIL
ASC-US-H
AGC

Front 28

OK to do HPV DNA typing for patients with:

Back 28

ASC-US

Front 29

Women older than 30 yrs, HPV with PAP test. If both are negative, pt does not need further combined testing for how long?

Back 29

3 years

Front 30

Women older than 30 yrs, HPV with PAP test. If PAP normal and HPV positive, pt does not need further combined testing for how long?

Back 30

6-12 months

Front 31

Time for CIN 3 to progress to invasive cancer averages how many years?

Back 31

8.1-12.9 years

Front 32

Do you need HPV to get cervical cancer?

Does HPV cause cervical cancer all by itself?

Back 32

yes

no

Front 33

HPV 16 and 18 are observed in ____ of the cervical cancer cases

Back 33

2/3

Front 34

___% of women with LSIL are positive for high risk.

Back 34

83

Front 35

Likelihood of regression for CIN 1 = ___%.
Likelihood of regression for CIN 2 = ____%.

Back 35

60

40

Front 36

Most predominant risk factor for genital HPV is _______. Next is ______.

Back 36

the number of lifetime sexual partners

young age

Front 37

Most HPV infections are transient and are acquired about 3 yrs after ________.

Back 37

coitarche

Front 38

Most infected with HPV can produce an immune response and can clear the infection over how long?

Back 38

1-2 yrs

Front 39

High risk HPV = ________ (what numbers?)

Back 39

16, 18, 31, 33, 35, 45, 52, 58.

Front 40

HPV ___ are associated with genital warts.

Back 40

6, 11

Front 41

Gardisil vaccine covers HPV numbers ________. Recommended for girls ages 9-26

Back 41

6,11,16,18

Front 42

Genital or venereal warts (condylomata _______).

Back 42

acuminata

Front 43

is condylomata acuminata a reprotable STD?

Back 43

no

Front 44

Treatment of genital warts.

Back 44

Usually resolve spontaneously.
Patient-applied include Podofilox and Aldara cream
Provider-administered include TCA, BCA, cryptherapy, excision and laser.

Front 45

Atypical cells often occur in the vagina without HPV or neoplasia.
Cellular changes are reactive and reparative secondary to life events like what?

Back 45

( tampons, intercourse, BV, yeast, aging and decreased estrogen).

Front 46

Three treatment options for ASCUS

Back 46

1. HPV DNA typing. If it comes back as high risk must have a colposcopy.
2. Colposcopy.
3. Repeat PAP at 6 and 12 months.
Reflex HPV DNA typing is preferred. If negative, have a less than 2% risk of CIN2/3. Just repeat PAP in 1 yr.
Adolescents = follow up PAP in 6 and 12 months.

Front 47

If ASCUS pts are high-risk-HPV postitive, what do you do?

Back 47

proceed to colposcopy. If high risk negative, PAP test in 1 yr.

Front 48

what do you do if report comes back as ASCUS-H? (cannot rule out high grade lesion)

Back 48

colposcopy with biopsies, ectocervical and endocervical

Front 49

Your pt has LSIL – Low grade Squamous Intraepithilial Lesion.
Mild Dysplasia. It is associated with HPV high risk. what is the next step?

Back 49

Next step is colposcopy with biopsies if indicated. Include ectocervix and endocervix.

Front 50

If biopsy confirms LSIL, two options:

Back 50

1) Follow with PAP every 4-6 months. After three consecutive normal PAPs, return to annual PAPs.
2) Treatment with cryosurgery, laser ablation or excision, LEEP, CKC, then follow up PAP’s.

LEEP = loop electro excision
CKC = cold knife conization

Front 51

Your pt has HSIL – High grade Squamous Intraepithelial Lesion
Moderate to severe dysplasia. CIN 2/3 in 70% of women.
What's next?

Back 51

Colposcopy with ectocervical and endocervical biopsies.

Front 52

What if HSIL pt's endo/exo biopsies match?

Back 52

If they match next step is an excisional or ablative procedure.

Front 53

What if HSIL pt's endo/exocervical biopsies don't match?

Back 53

If they don’t match, ask the pathologist to review the material. If they uphold their original diagnosis an excisional DIAGNOSTIC procedure is performed. Then, if they change their diagnosis then follow those guidelines.
Follow up PAP’s every 4-6 months until three consecutive normal PAP’s.

Front 54

HSIL AKA?

Back 54

Carcinoma in situ

Front 55

If your excision of HSIL doe not have clear margins, what next?

Back 55

Re-cone and try again.

--> Hysterectomy, but be sure of no invasive cancer.

Front 56

what are glandular cells?

Back 56

Endocervical cells envaginate into the cervical stroma 5-8.mm. Referred to as glands.

Front 57

If PAP is reported as AGC NOS (abn glandular cells, not otherwise specified), what do you do next?

Back 57

Colposcopy with ectocervical, endocervical and endometrial biopsies.
If negative, can follow up PAP test and ECC every 6 months.

Front 58

PAP reported as AGC favors neoplasia:
Colposcopy with same biopsies.
If biopsies are negative, what do you do?

Back 58

do excision.

Front 59

What causes Benign changes with AGC ?

Back 59

chronic endocervicitis, IUD use and OCP’s

Front 60

All AGC go to colposcopy with biopies. Also do an ______ biopsy. Difficult to see glandular atypia on colposcopy.

Back 60

endometrial

Front 61

If invasive disease, refer to the GYN/ONC.
If no invasive disease and AGC NOS, no abnormal pathology, what do you do next?

Back 61

can go to PAP every 4-6 months until 3 consecutive normal.

Front 62

If no invasive disease AGC NOS and biopsy is CIN or AIS, _____ is indicated.

Back 62

excisional biopsy

Front 63

If no invasive disease and AGC favors dysplasia, next step is a __________

Back 63

Cold Knife Conization

Front 64

Treat PAP in a pregnant woman like a non-pregnant woman. ie: go to colposcopy if necessary.
Goal is to r/o invasive cancer.
Do NOT do an _______ biopsy

Back 64

endocervical

Front 65

With pregnant pt, Instead of follow up PAP’s do _____ each trimester

Back 65

colposcopy

Front 66

How often do you do PAPs on HIV or immunocompromised pt?

Back 66

every 6 months

Front 67

Visualization of the entire _____ is required for a satisfactory colposcopic exam.

Back 67

TZ

Front 68

95% of CIN/cancer is in the ____

Back 68

TZ

Front 69

If you cannot see the entire TZ, what do you do?

Back 69

CKC

Front 70

Criteria associated with abn areas of TZ

Back 70

White epithelium
Abnormal vascular patterns
Punctuated areas
Mosaic patterns
Decreased uptake of Lugols solution

Front 71

If there is a greater than a 2 step discrepancy with PAP and biopsy the a _____ is indicated

Back 71

CKC

Front 72

During colposcopy, do ECC (endocervical ______)

Back 72

currettage

Front 73

Always do what test before doing a colposcopy? Why?

Back 73

HCG

ECC can interupt the pregnancy