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cervical cytology

Cervical Cytology

Risk Factor for cervical cancer intercourse at an early age, number of lifetime partners, cigarette smoking, HPV
Who is most likely to get cervical cancer Women who are screened sporadically or never screen
HPV Facts Frequently asymptomatic and transmission occurs unknowingly including genital skin to skin contact Condoms not 100% protective  HPV testing detects strains of the virus that are sociated with a high risk of cervical neoplasia
Which types of HPV are associated with rapid progression of cervical dysplasia Type 16-18 assoc. with more rapid progression to cervical dysplasia than other types
How long does it take for HPV to clear up up to 24 months
Causes genital warts (condyloma) as well as other cancer including anal, penile,vulvar, vaginal and oropahryngeal HPV
When should the HPV vaccine be given routine vaccination for all males and females ages 11-12 and catch up vaccination for females through age 26 and males through age 21 o 2 dose series (before age 15) 0, 6-12 o 3 dose series (after age 15) 0, 1-2, 6
HPV screening guidelines Adjunct to cytology for screening women age 30 or older Management of women age 21 or older with ASCUS pap Management of postmenopausal women with LSIL pap
When don't you screen for HPV NOT recommended for routine screening in women < 30 years or in women considering vaccination against HPV
How frequently should cytology screening be performed on age 21-29 Every three years
How frequently should cytology screening be performed on age 30-65 Cytology + HPV co-testing Every 5 Years HPV testing alone Every 5 years Cytology alone Every 3 years
When should you stop screening for cervical cancer Age 65 if negative prior screen and CIN II
How long should women be screened with a + hx of CIN2 or Adenocarcinoma Women aged > 65 with a history of CIN 2 or > or with a history of adenocarcinoma in situ should continue screening for at least 20 years
Screening requirements for women with hysterectomy Continue after supra-cervical hysterectomy where the cervix is still present. Total hys, surgery indication should dictate the necessity for screening. Continue if hyst was done as a tx for cervical HIGH GRADED lesions or cancer.
If hx of CIN 2 or >, where might CA reoccur If hx of CIN 2 or >, still at risk of recurrent CA at the vaginal cuff
Populations Not Appropriate for New Screening Guidelines Women with HIV who or are immunosuppressed Exposed to diethylstilbestrol in utero Previously treated for CIN 2, CIN 3, or cancer
Satisfactory Pap Specimen Approximately 5000 cells needed Absent or insufficient endocervical cells/transformation zone component noted May note obscuring blood of inflammation
ASC-US Atypical squamous cells of undetermined significance (ASC-US)—not normal but not Ca
ASC-H Atypical squamous cells of undetermined significance cannot exclude HSIL
AGC Atypical Glandular Cells-AGC--- highly suggestive of Ca
Unsatisfactory HPV unknow at any age HPV negative or positive >30 Repeat Cytology after 2-4 months
Repeat cytology after 2-4 months and negative Routine screening or cotesting @ 1 yr if HPV neg
Repeat cytology after 2-4 months and Unsatisfactory Colposcopy
> 30 cytology neg HPV + Repeat cotesting in a yr or HPV DNA typing If + after repeat testing colpo
Created by: shirley.w.wscott
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