Cervical Cancer Screening Abnormalities PDF

Chapter 149 Cervical Cancer Screening Abnormalities Definition  Papanicolaou (Pap) is a screening test for cervical cancer.  2.1% of findings show abnormal results (United States).  13 HPV subtypes are correlated with high risk for cervical dysplasia.  Especially types 16...

Chapter 149 Cervical Cancer Screening Abnormalities Definition  Papanicolaou (Pap) is a screening test for cervical cancer.  2.1% of findings show abnormal results (United States).  13 HPV subtypes are correlated with high risk for cervical dysplasia.  Especially types 16 and 18 (account for 70% of all cervical cancers )  HPV is the most common STI in the United States. Pelvic Exam Cervical Cancer Risk Factors ⚫ Older age ⚫ Infection with particular high-risk HPV types ⚫ Vaginal pH changes ⚫ Hormonal changes ⚫ Cellular trauma ⚫ Long-term use of combined hormonal contraception ⚫ Young age at coitarche ⚫ Multiparity ⚫ History of STIs: sexual partner with a history of STIs, more than five lifetime sexual partners, younger age at first pregnancy, and cigarette smoking Clinical Presentation  Cervical Pap abnormalities are not visible by routine speculum exam.  However, frank cervical cancer may appear as a lesion on the cervix.  Guidelines  Begin Pap screening for all women at age 21 years.  HPV testing is indicated for women ages 30 to 65. Screening  If You Are 21 to 29 Years Old  You should start getting Pap tests at age 21. If your Pap test result is normal, your doctor may tell you that you can wait three years until your next Pap test. Screening continued 30 to 65 years old  An HPV test only. This  An HPV test along is called primary HPV with the Pap test. This testing. If your result is is called co-testing. If normal, your doctor both of your results are may tell you that you normal, your doctor can wait five years until may tell you that you your next screening can wait five years until test. your next screening test.  For 65 Years and Older You have had normal screening test results for several years, and You have not had a cervical precancer in the past, or You have had your cervix removed as part of a total hysterectomy for non-cancerous conditions, like fibroids. Physical Exam and Diagnostics  HPV/Pap test  Currently, screening by HPV alone, without a Pap done simultaneously, is not recommended.  Pap and HPV screening every 3 years in the 30- to 65-year age range  No Pap or HPV screening for women over 65 who have had 3 normal consecutive Paps  Women who have a history of CIN II or greater should continue screening past the age of 65 for a minimum of 20 years.  Women who have had a hysterectomy and had their cervix removed should have screening discontinued unless they have a history of CIN II or greater in the past 20 years or have ever had cervical cancer.  Women who have had DES exposure, immunosuppressed HIV, or CIN II or greater require closer monitoring.  Cytologic brush  Broom liquid-based medium Management  Patients with ASC-US lesions, with a concurrent positive HPV DNA test result should be referred for colposcopy, unless they are under 24 years of age.  Repeat cytology in women under 24 years of age in 12 months.  Can choose to have a reflex HPV test run after the initial or repeat cytology in 12 months, without running a reflex HPV test.  Women over the age of 24 positive for ASC-US HPV should be referred for colposcopy.  Gynecologic consultation is indicated for abnormal Pap findings— colposcopy diagnostics.  Colposcopy  Colposcopy is a way of looking at the cervix, vagina, and vulva through a special magnifying device  A microscope (colposcope) with a strong light will be used to look at your cervix. The colposcope doesn't enter the vagina and remains outside your body. If the colposcope has a camera attached to it, the patient may be able to see images of the cervix on a small screen. Some solutions will be applied to the cervix to highlight the abnormal areas. Colposcopy Treatments  Less than 1 in 1,000 women referred  Mild abnormalities don't always need for a colposcopy are found to have to be treated. If treatment is needed, cervical cancer that requires the aim is to remove the abnormal immediate treatment. cervical cells while preserving as much normal tissue as possible.  The most common treatment is large loop excision of the transformation zone (LLETZ). The transformation zone is the area of tissue just at the entrance of the birth canal. LLETZ involves using a heated wire loop to  https://www.nhsinform.scot/test remove the abnormal cells, and in the s-and-treatments/non-surgical- majority of cases is carried out using procedures/colposcopy#:~:text=I a local anaesthetic. The procedure ntroduction,where%20it%20ente lasts a few minutes and can be rs%20the%20womb. carried out during a colposcopy.  Removing abnormal cervical cells is usually successful (about a 90% success rate).Follow-up cervical screening test to check that the treatment has been successful.