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Gyn DM Pap/Biopsy
Pap Smear, Colposcopy/endometrial biopsy
| Question | Answer |
|---|---|
| 2nd most common cancer worldwide | cervical cancer |
| Highest incidence of cervical cancer in women ages | 20-50 |
| Prevalence of HPV infection in ages 14-59 | 26% |
| ____% of women get HPV 2 years after first sex | 50%. Usually transient, rarely lifelong |
| How to prevent HPV infection | avoid smoking, use condoms, limit partners, vaccine |
| How often is a pap smear reocommended according to USPSTF? | at least every 3 years. Start at age 21 or within 3 years of sexual debut |
| Where should you sample a cervix? | At the white border where squamous and columnar cells meet = squamocolumnar junction. This is where cancer most often occurs |
| Organisms on a pap | yeast, bacterial vaginosis, Trichomonas |
| ASCUS | Atypical Squamous Cells of Undetermined Significance (something is wrong but we don't know what it is) |
| LSIL | Low grade squamous intraepithelial lesion |
| HSIL | high grade squamous intraepithelial lesion |
| AGC | Atypical Glandular Cells (this is the most worrisome pap; can't see this with the naked eye, need to ask about hx of bleeding) |
| Interpretation of Pap results depends on | the age of the woman |
| In an adolescent woman with ASC-US or LSIL the next step is | to repeat cytology in 12 months. If then the woman has > or equal to HSIL, get a colposcopy. If less than HSIL, repeat cytology in 12 months |
| In an adolescent woman with HSIL who is - for CIN 2,3 the next step is | Observation with Colposcopy and Cytology every 6 months for up to 2 years. A high grade Colpscopy lesion or HSIL that persists for 1 year should then be biopsied |
| Management of women with ASCUS | Repeat cytology at 6months, Colposcopy, HPV DNA Testing |
| ASC-H | Atypical Squamous Cells cannot rule out High Grade dysplasia. (note: pap smears are not diagnostic, they are screening tests and 80% of the time are appropriate) |
| Pregnant women with low-grade Squamous Intraepithelial Lesion (LSIL) | Colposcopy or Defer Colposcopy. Don't brush or currettage the endocervix in pregnancy |
| Management of women with High-grade Squamous Intraepithelial Lesion (HSIL) | Immediate Loop Electrosurgical Excision or Colposcopic Examination |
| 3 parts of Atypical Glandular Cell (AGC) work up | Colposcopy, endocervical brushing, endometrial biopsy |
| Preparing your patient for Colposcopy | refer to colposcopist, make sure she is not in her menses, premedicate with motrin 400-800mg to reduce cramps. Colposcopist will use vinegar and possibly Iodine (iodine stains only normal tissue): Lugols or Schiller test. Do a pregnancy test before. |
| Preparing your patient for what they can expect post-Colposcopy | expect mild cramping, discharge will be a mixture of blood and monsels (used to stop bleeding), will occasionally get an odor several days later due to a mild vaginal infection (10%) |
| CIN | Cervical Intraepithelial Neoplasia - used to describe abnormal tissue findings. Diagnostic term used from biopsy/colposcopy |
| Dysplasia | is a cytology dx, screening, from Pap smear |
| If you need to bx the anterior and posterior portion of the cervix, first bx | the posterior so that bleeding will not contaminate the anterior bx |
| Tx of cervical abnormalities | Cryotherapy of Cervix, LEEP (loop electrosurgical excision procedure), Laser, Cervical Conization |
| Risks of cervical tx | antibodies to sperm, cervical stenosis, incompetent cervix, missing a significant lesion |
Created by:
ltm12