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cervical cytology
Cervical Cytology
| Question | Answer |
|---|---|
| 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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