Podcast
Questions and Answers
What is the most common type of cervical cancer?
What is the most common type of cervical cancer?
Metaplasia is considered a premalignant condition.
Metaplasia is considered a premalignant condition.
False
What is the dynamic area between the old and new squamocolumnar junction called?
What is the dynamic area between the old and new squamocolumnar junction called?
Transformation Zone
The ______ zone is the most common site for Squamous Cell Carcinoma.
The ______ zone is the most common site for Squamous Cell Carcinoma.
Signup and view all the answers
Match the following features with either Metaplasia or Dysplasia:
Match the following features with either Metaplasia or Dysplasia:
Signup and view all the answers
At what age is HPV DNA testing recommended to begin?
At what age is HPV DNA testing recommended to begin?
Signup and view all the answers
The Hybrid Capture technique identifies the specific subtype of HPV.
The Hybrid Capture technique identifies the specific subtype of HPV.
Signup and view all the answers
What is indicated by a white appearance during visual inspection?
What is indicated by a white appearance during visual inspection?
Signup and view all the answers
The presence of bleeding after sexual intercourse is known as ______.
The presence of bleeding after sexual intercourse is known as ______.
Signup and view all the answers
Match the visual inspection appearance with its inference:
Match the visual inspection appearance with its inference:
Signup and view all the answers
What is the initial test recommended for screening in the general population starting at 30 years old?
What is the initial test recommended for screening in the general population starting at 30 years old?
Signup and view all the answers
HPV DNA testing for HIV positive individuals should be repeated every 5-10 years.
HPV DNA testing for HIV positive individuals should be repeated every 5-10 years.
Signup and view all the answers
What treatment is preferred for dysplastic epithelium during cervical screening?
What treatment is preferred for dysplastic epithelium during cervical screening?
Signup and view all the answers
Cervical screening should start at age _______ and stop at age _______.
Cervical screening should start at age _______ and stop at age _______.
Signup and view all the answers
Match the following HPV testing recommendations with their respective patient categories:
Match the following HPV testing recommendations with their respective patient categories:
Signup and view all the answers
Which of the following HPV vaccines is nonavalent?
Which of the following HPV vaccines is nonavalent?
Signup and view all the answers
Screening for gynecologic cancers should start at the age of 21, regardless of sexual activity history.
Screening for gynecologic cancers should start at the age of 21, regardless of sexual activity history.
Signup and view all the answers
What is the recommended frequency for Pap smear tests from age 21 to 30?
What is the recommended frequency for Pap smear tests from age 21 to 30?
Signup and view all the answers
The __________ vaccine is bivalent and targets HPV subtypes 16 and 18.
The __________ vaccine is bivalent and targets HPV subtypes 16 and 18.
Signup and view all the answers
Match the HPV vaccine to its characteristics:
Match the HPV vaccine to its characteristics:
Signup and view all the answers
What is the risk of cancer associated with CIN 2?
What is the risk of cancer associated with CIN 2?
Signup and view all the answers
CIN is diagnosed solely on the basis of a pap smear.
CIN is diagnosed solely on the basis of a pap smear.
Signup and view all the answers
Which pap smear finding corresponds with the need for antibiotics?
Which pap smear finding corresponds with the need for antibiotics?
Signup and view all the answers
CIN 1 has a cancer risk of approximately ____%.
CIN 1 has a cancer risk of approximately ____%.
Signup and view all the answers
Match the following Pap smear findings to their significance:
Match the following Pap smear findings to their significance:
Signup and view all the answers
Which instrument is used to collect a sample from the ectocervix during a pap smear?
Which instrument is used to collect a sample from the ectocervix during a pap smear?
Signup and view all the answers
An endocervical brush is used for taking samples from the ectocervix.
An endocervical brush is used for taking samples from the ectocervix.
Signup and view all the answers
What does a pap smear primarily identify?
What does a pap smear primarily identify?
Signup and view all the answers
The sample from the ectocervix is collected using a ______ spatula.
The sample from the ectocervix is collected using a ______ spatula.
Signup and view all the answers
Match the following cervical conditions with their characteristics:
Match the following cervical conditions with their characteristics:
Signup and view all the answers
What is the FDA-approved age range for high-risk females to receive the HPV vaccine?
What is the FDA-approved age range for high-risk females to receive the HPV vaccine?
Signup and view all the answers
The goal of the WHO SAGE recommendations is to vaccinate 90% of females by age 18.
The goal of the WHO SAGE recommendations is to vaccinate 90% of females by age 18.
Signup and view all the answers
How many doses of the HPV vaccine are recommended for individuals aged 21 years and older?
How many doses of the HPV vaccine are recommended for individuals aged 21 years and older?
Signup and view all the answers
Females who are sexually active, females with HPV, and ______ should be administered the HPV vaccine.
Females who are sexually active, females with HPV, and ______ should be administered the HPV vaccine.
Signup and view all the answers
Match the following age groups with their recommended HPV vaccine doses:
Match the following age groups with their recommended HPV vaccine doses:
Signup and view all the answers
What is the best time to perform a pap smear?
What is the best time to perform a pap smear?
Signup and view all the answers
Liquid-based cytology samples can be tested during menstruation.
Liquid-based cytology samples can be tested during menstruation.
Signup and view all the answers
What type of fixation is used in liquid-based cytology?
What type of fixation is used in liquid-based cytology?
Signup and view all the answers
Active __________ is a relative contraindication for liquid-based cytology.
Active __________ is a relative contraindication for liquid-based cytology.
Signup and view all the answers
Match the following cytological cell types with their respective counts in Conventional Pap versus Liquid Based Cytology:
Match the following cytological cell types with their respective counts in Conventional Pap versus Liquid Based Cytology:
Signup and view all the answers
Which screening method is considered the most sensitive for detecting HPV?
Which screening method is considered the most sensitive for detecting HPV?
Signup and view all the answers
The WHO goal for vaccination coverage against cervical cancer is set at 80% by age 15.
The WHO goal for vaccination coverage against cervical cancer is set at 80% by age 15.
Signup and view all the answers
What is the recommended age for the start of cervical screening according to the WHO protocol?
What is the recommended age for the start of cervical screening according to the WHO protocol?
Signup and view all the answers
The persistent HPV infection can lead to _____, which may progress to cervical cancer.
The persistent HPV infection can lead to _____, which may progress to cervical cancer.
Signup and view all the answers
Match the following screening methods with their characteristics:
Match the following screening methods with their characteristics:
Signup and view all the answers
Which of the following HPV subtypes accounts for approximately 50% of cervical cancer cases?
Which of the following HPV subtypes accounts for approximately 50% of cervical cancer cases?
Signup and view all the answers
HPV 6 and HPV 11 are considered high-risk subtypes for cancer development.
HPV 6 and HPV 11 are considered high-risk subtypes for cancer development.
Signup and view all the answers
What is the role of the E1 and E2 proteins in HPV?
What is the role of the E1 and E2 proteins in HPV?
Signup and view all the answers
HPV is known to knock out the ______ gene, resulting in immortal cells.
HPV is known to knock out the ______ gene, resulting in immortal cells.
Signup and view all the answers
Match the following cancers with the gender primarily affected:
Match the following cancers with the gender primarily affected:
Signup and view all the answers
Study Notes
HPV Testing and Cervical Abnormalities
- HPV DNA Testing: Performed at age 30 or older, using the Hybrid Capture technique. Detects high-risk HPV infection but not specific subtypes.
- Subtype Testing: Includes Onclarity, Cobas, and Partial Genotyping tests.
- Cotesting (HPV + Pap test): If Pap test shows abnormalities, a follow-up HPV test is conducted. Helps determine HPV infection presence and type.
-
Visual Inspection (VIA and VILI):
- Acetic Acid (VIA): Applying 3-5% acetic acid highlights dysplastic cells, making them appear white.
- Visual Inspection with Lugol's Iodine (VILI): Staining with Lugol's iodine differentiates normal (pink) from abnormal (white) epithelium.
Squamous Metaplasia
- Definition: Squamous epithelium replaces columnar epithelium.
- Transformation Zone: Dynamic area between old and new squamocolumnar junction.
- Position Changes: Influenced by hormonal status, common during pregnancy and menopause.
-
Cancer Cervix:
- Squamous Cell Carcinoma is the most common type.
- Transformation Zone is the most common site.
- Endocervix is usually the site for adenocarcinoma.
- Pap Smear: Samples are taken from the Transition and Endocervix zones.
-
Metaplasia vs Dysplasia:
- Metaplasia is physiological, not premalignant, and occurs in all females.
- Dysplasia is pathological, premalignant, and occurs in the presence of risk factors.
Gynaecologic Oncology
-
Active Space:
- HPV DNA approach recommends screening from 30 to 49 years.
- Repeat HPV DNA testing every 5-10 years (general population) or 3-5 years (HIV positive).
- Treatment for positive HPV DNA tests includes LLETZ/LEEP or Cryoablation.
- Cervical Screening (VIA approach): Apply 3-5% acetic acid to the cervical epithelium.
- Normal epithelium: Repeat screening every 3 years.
- Dysplastic epithelium: Requires further evaluation and treatment.
-
Management:
- Repeat HPV DNA test every 1-2 years.
- LLETZ (Large loop excision of transformation zone).
- LEEP (Loop electrosurgical excision procedure).
- Cryosurgery: Applicable for non-HIV patients with dysplastic areas covering less than 2 quadrants of the cervix.
-
General Screening Guidelines:
- General population: Every 5-10 years.
- HIV positive: Every 3 years.
- Screening starts at 30 years and ends at 50 years.
ACOG Recommendations
- Screening from 21 years: Pap smear every 5 years until 30 years.
- Screening from 30-65 years: HPV DNA testing + Pap smear (Cotest) every 5 years.
Notable Points
- Hysterectomy: Stop screening after hysterectomy.
- Begin Sexual Activity before 21: Screening starts at 21 years of age.
- Females 55-65 years: Continue screening if one abnormal Pap smear is present.
- Screening: Screening continues up to 75 years of age, even after HPV vaccination.
HPV Vaccines
- All vaccines are produced from the L1 capsid protein.
- Cervavac (Quadrivalent): Subtypes: HPV 6, 11, 16, 18. Protects against genital warts and cervical cancer.
- Gardasil (Quadrivalent): Subtypes: HPV 6, 11, 16, 18.
- Cervarix (Bivalent): Subtype: HPV 16, 18.
- Gardasil 9 (Nonavalent): Subtypes: HPV 6, 11, 16, 18, 31, 33, 45, 52, 58. Most common HPV vaccine in the US.
- Age Recommendations: Ideal age is 11-12 years, but can be administered from 9-26 years.
CIN: Part 2
- CIN: Cervical intraepithelial neoplasia.
-
CIN and Risk of Cervical Cancer:
- CIN 1: ~1% risk.
- CIN 2: ~5% risk.
- CIN 3: ~12-40% risk.
- Diagnosis: CIN is diagnosed on biopsy, not on a Pap smear.
-
WHO guidelines on management:
- Limited resource countries: Screening with HPV DNA ± VIA. Biopsy is not mandatory.
- Resource-rich countries: Abnormal Pap smear leads to biopsy, and CIN 1/2/3 requires further management.
Pap Smear
- Normal.
- Infection: Requires antibiotic treatment.
- Low squamous intraepithelial lesion (LSIL).
- High squamous intraepithelial lesion (HSIL).
- Atypical squamous cells of unknown significance (ASCUS).
- Atypical squamous cells where HSIL cannot be ruled out (ASC-H).
- Atypical glandular cells of unknown significance (AGCUS).
Pap Smear Instruments
- Ayres spatula: Used to collect samples from the ectocervix.
- Endocervical brush: Used to collect samples from the endocervix.
Samples
- Ectocervix: Sample is taken from the transition zone using a bifid end of Ayres spatula, near the external os.
- Endocervix: Sample is collected using an endocervical brush.
Applied Aspect
- CIN diagnosis: Made through biopsy or tissue sample.
- Pap smear: Identifies dysplasia, but cannot assess the extent.
- Abnormal Pap smear: Requires follow-up with biopsy.
Cervical Epithelial Thickness and Carcinoma
- Cervical epithelial thickness: Varies with types of carcinoma.
HPV Vaccine Information
- High-Risk Females: Approved by FDA for ages 27-45 years. WHO SAGE recommends vaccinating 90% of females by age 15.
-
Dosage:
- 9-20 years: 1/2 doses.
- ≥21 years: 3 doses.
-
Recipients:
- HIV+ve individuals.
- Sexually active females.
- Females with HPV.
- Boys (should be administered).
Liquid Based Cytology
- Procedure: Smear samples are put on the same slide and fixed with 95% ethyl alcohol ± 5% ether. Do not air dry the slide.
- Relative Contraindication: Active bleeding.
- Best Time: Periovulatory phase.
- Separate Cervico-vaginal Swab: Collected for HPV DNA testing.
-
Advantages:
- Same sample for Pap smear and HPV testing.
- Can be tested during menstruation.
- Fewer unsatisfactory smears.
Prevention of HPV Infection
-
Screening: Aims to detect and manage HPV infection.
- 90% of HPV infections resolve.
- 10% persist leading to dysplasia, CIN, cancer in situ, and cervical cancer.
-
WHO Goals (2030):
- 90% coverage for cervical cancer vaccination by 15 years old.
- 70% screened by 35 years, repeated at 45 years, and receive appropriate treatment.
- 90% with CIN or cervical cancer treated.
-
Screening Methods:
- Most sensitive: HPV DNA testing (sensitivity 85-90%).
- Most specific: Pap smear (sensitivity 55%).
- Recommended by WHO: VIA (visual inspection with acetic acid).
- Not recommended by WHO: VILI (visual inspection with Lugol's iodine).
-
Screening Protocol:
- Resource-rich countries: ACOG protocol.
- Resource-limited countries: WHO protocol.
- WHO Protocol: Begins at 30 years old and ends at 50 years old.
-
Approaches:
- See & treat: 1st screening +ve → HPV DNA testing → VIA.
- See, triage & treat: 1st screening +ve → 2nd screening +ve → treatment.
Gynaecologic Oncology
- HPV: Epitheliotropic virus that completes its life cycle in epithelial cells. Affects basal and parabasal cells, and completes its cycle in superficial cells.
- Malignant Transformation: Knocks out p53 and retinoblastoma genes, leading to immortal cells.
- Subtypes and Functions: E1 and E2 proteins are involved in viral replication, upregulating E6 and E7.
-
High-Risk Subtypes:
- HPV 16 and HPV 18 (70% of cervical cancer cases).
- HPV 16 (50% of cervical cancer cases).
- HPV 18 (most specific subtype).
- Other subtypes (31, 33, 35, 54, 58).
-
Cancer:
- Males: Penis cancer, anal cancer, oropharyngeal cancer.
- Females: Cervical cancer, vulvar cancer, vaginal cancer.
-
Low-Risk Subtypes:
- HPV 6 and 11: Genital warts/Condyloma Acuminata.
- Treatment for pregnant females: Trichloroacetic acid (TCA).
- Laryngeal papilloma in newborns.
Pap Smear Instruments
- Ayres spatula: Used to collect samples from the ectocervix.
- Endocervical brush: Used to collect samples from the endocervix.
Samples
- Ectocervix: Sample is taken from the transition zone using a bifid end of Ayres spatula, near the external os.
- Endocervix: Sample is collected using an endocervical brush.
Applied Aspect
- CIN diagnosis: Made through biopsy or tissue sample.
- Pap smear: Identifies dysplasia, but cannot assess the extent.
- Abnormal Pap smear: Requires follow-up with biopsy.
Cervical Epithelial Thickness and Carcinoma
- Cervical epithelial thickness: Varies with types of carcinoma.
HPV Vaccine Information
- High-Risk Females: Approved by FDA for ages 27-45 years. WHO SAGE recommends vaccinating 90% of females by age 15.
-
Dosage:
- 9-20 years: 1/2 doses.
- ≥21 years: 3 doses.
-
Recipients:
- HIV+ve individuals.
- Sexually active females.
- Females with HPV.
- Boys (should be administered).
Liquid Based Cytology
- Procedure: Smear samples are put on the same slide and fixed with 95% ethyl alcohol ± 5% ether. Do not air dry the slide.
- Relative Contraindication: Active bleeding.
- Best Time: Periovulatory phase.
- Separate Cervico-vaginal Swab: Collected for HPV DNA testing.
-
Advantages:
- Same sample for Pap smear and HPV testing.
- Can be tested during menstruation.
- Fewer unsatisfactory smears.
Prevention of HPV Infection
-
Screening: Aims to detect and manage HPV infection.
- 90% of HPV infections resolve.
- 10% persist leading to dysplasia, CIN, cancer in situ, and cervical cancer.
-
WHO Goals (2030):
- 90% coverage for cervical cancer vaccination by 15 years old.
- 70% screened by 35 years, repeated at 45 years, and receive appropriate treatment.
- 90% with CIN or cervical cancer treated.
-
Screening Methods:
- Most sensitive: HPV DNA testing (sensitivity 85-90%).
- Most specific: Pap smear (sensitivity 55%).
- Recommended by WHO: VIA (visual inspection with acetic acid).
- Not recommended by WHO: VILI (visual inspection with Lugol's iodine).
-
Screening Protocol:
- Resource-rich countries: ACOG protocol.
- Resource-limited countries: WHO protocol.
- WHO Protocol: Begins at 30 years old and ends at 50 years old.
-
Approaches:
- See & treat: 1st screening +ve → HPV DNA testing → VIA.
- See, triage & treat: 1st screening +ve → 2nd screening +ve → treatment.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Description
Test your knowledge on HPV DNA testing, subtype testing, and the significance of co-testing with Pap tests. Explore visual inspection methods and understand squamous metaplasia in the context of cervical health. This quiz aims to reinforce concepts surrounding HPV and cervical abnormalities for health professionals.
