Patho - Advance Nursing

Running head: DISCUSSION POST 1

Chapter 20: Cervical Cancer Screening and Diagnosis

Anita Opdycke

Regis College

Pathophysiology NURS 606

Terri Kanner

May 12, 2020

DISCUSSION POST 2

Chapter 20: Cervical Cancer Screening and Diagnosis

Diagnostic testing is important in early detection of cancer (Hubert & VanMeter, 2018).

Hubert & VanMeter (2018), state that the examination of tumor cells is the only definitive

method to diagnose cancer cells. Other tests should be used in conjunction with cytologic tests

and to monitor treatment and follow up after a diagnosis is made (Hubert & VanMeter, 2018).

Cytologic testing, are used to screen individuals as high risk, to make a diagnosis, and to follow a

clinical plan of care or monitor (Hubert & VanMeter, 2018). To make a diagnosis, clinicians use

histologic and cytologic examinations to gather cells that are sent to a lab for further examination

(Hubert & VanMeter, 2018). In some cases, biopsies are retrieved and in other cases exfoliative

cytology is used to make a dependable confirmation of malignancy (Hubert & VanMeter, 2018).

For all tests, good technique and preservation of the sample is key in obtaining an accurate

evaluation (Hubert & VanMeter, 2018). The Papanicolaou (Pap) test is the standard of care for

screening, evaluating and diagnosing cervical cell changes that can lead to cervical cancer

(Hubert & VanMeter, 2018).

Cervical dysplasia, or atypical glandular cells on cervical cytology, are categorized based

on the degree of cellular change (Goodman & Huh, 2020). The three main categories of cervical

intraepithelial lesions (CIN) include: CIN-1 or lesser abnormalities, CIN 2 and CIN 3 (Goodman

& Huh, 2020). CIN-1 or lesser abnormalities includes atypical cells of undetermined significance

(AS-CUS) and low grade squamous intraepithelial lesions (LSIL) with HPV 16 or 18 infection,

or persistent HPV infection (Goodman & Huh, 2020). Low grade CIN has a low potential to

progress to malignancy (cancer) but high grade CIN has a high potential to develop into cancer

(Goodman & Huh, 2020). The Pap test has significantly contributed to the decrease in invasive

cervical cancer incidence however every year there are 12, 000 new cases of invasive cervical

DISCUSSION POST 3

cancer are diagnosed in the U.S (Zhao, et al., 2014). Zhao, et al. (2014) explored Factors

Associated with Reduced Accuracy in Papanicolaou Tests With Invasive Cervical Cancer in an

effort to highlight the importance of accurate interpretation of screening tests.

The study, Factors Associated with Reduced Accuracy in Papanicolaou Tests With

Invasive Cervical Cancer, was published in Cancer Cytopathology on May, 28, 2014. The

authors, Lichao Zhao, Nicolas Wentzensen, Roy Zhang, Terence Dunn, Michael Gold, Sophia

Want, Mark Schiffman, Joan Walker and Rosemary Zuna conducted research to explore and

evaluate the limiting factors in Pap tests from women who were diagnosed with invasive cervical

cancer and to discuss ways to identify problematic cases in clinical practice (Zhao, et al., 2014).

The literature was drawn from the discipline of oncology or the study of cancer. The authors

conducted a cross sectional analysis of cytologic and HPV results by studying 3003 women who

had a wide range of cervical lesions via the ThinPreP Pap test and HPV genotyping (Zhao, et al.,

2014). The methods and materials for the study included recruiting 3015 women, aged 18 and

older, referred for colposcopy from 2002-2010 into the Study to Understand Cervical Cancer

Early Endpoints and Determinants (SUCCEED) and the National Cancer Institute University of

Oklahoma Health Sciences Center Biopsy Study (Biopsy Study) (Zhao, et al., 2014).

All women who were recruited had a spectrum of benign, intraepithelial, and invasive

cervical neoplasia (Zhao, et al., 2014). Twelve participants were excluded due to previous

surgical treatment for cervical neoplasia, non-cervical neoplasm, pregnancy or HIV infection

(Zhao, et al., 2014). Each participant has a colposcopic visit as their first visit, which also

included a ThinPrep Pap test (Zhao, et al., 2014). HPV genotyping was also performed on the

specimens (Zhao, et al., 2014). Zhao, et al. (2014) noted that all cases within this research study

attempted to mimic the normal screeing process (Zhao, et al., 2014). As such, this study bias

DISCUSSION POST 4

could have caused some results that were diagnosed as “abnormal” to have been classified as

“unsatisfactory” in a normal clinic setting (Zhao, et al., 2014). This gap could have

underestimated the unsatisfactory rate for these women in a clinical setting (Zhao, et al., 2014).

The results used the Pearson chi-square and Fisher exam test and statistical significance was

assisgned to 2-sided probablity values <0.. The findings of the study concluded that there was a

statistical significance demonstrating patients with cervical cancer have a significantly higher

rate of unsatisfactory and limited quality Pap tests (Zhao, et al., 2014). This poses a challenge

for providers to deliver timely treatment, especially in women who do not obtain regular

screening (Zhao, et al., 2014). The major reasons leading to an unsatisfactor test results included

scant cellularity, obscuring blood, and inflammation or the presence of lubrication (Zhao, et al.,

2014).

Implications for further research include investigating the incidence of falsely negative

PAP tests, particularly in women with adenocarcinoma, decreasing testing intervals in women

over 30 or who have previous tested positive for HPV (Zhao, et al., 2014). The information in

the article could be applied to advance nursing practice by being aware of PAP technique,

adhering to best practice, ensure follow up for screeing for high risk female populations, and

being aware of post-exam bleeding and/or a friable cervix and the implications this may have on

the specimen collected (Zhao, et al., 2014). I would recommend this article to a collegue and

classmate to further understand the classification of cervical cell changes in the presence of HPV

genotype and the implications for progression to malignant carcinoma.

DISCUSSION POST 5

References

Goodman, A., & Huh, W. (2020, April). Cervical Cytology Evaluation. Retrieved from UptoDate: https://www.uptodate.com/contents/cervical-cytology-evaluation-of-atypical-and- malignant-glandular- cells?search=cervical%20dysplasia&topicRef=3215&source=related_link

Hubert, R. J., & VanMeter, K. C. (2018). Gould's Pathophysiology for the Health Professions (6th ed.). St. Louis: Elsevier.

Zhao, L., Wentzensen, N., Zhang, R., Dunn, T., Gold, T., Wang, S., . . . Zuna, R. (2014). Factors associated with reduced accuracy in Papanicolaou tests for patients with invasive cervical cancer. 1-8. Retrieved from https://acsjournals.onlinelibrary.wiley.com/doi/epdf/10.1002/cncy.21443