APGO MEDICAL STUDENT EDUCATIONAL OBJECTIVES, 11TH EDITION
Teaching Case
Student Name:
Educational Topic 52:
Cervical Dysplasia and Neoplasia
Rationale: Early recognition and proper evaluation of pre-invasive cervical disease and cancer can
reduce morbidity and mortality, impacting population health. Social and environmental factors,
including economic, ethnic, and racial disparities in access to care, may influence early recognition,
proper evaluation, and health outcomes.
Intended Learning Outcomes:
A student should be able to:
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Describe the pathogenesis of cervical cancer.
Complete a history to identify risk factors for cervical neoplasia and cancer, with an
understanding of social and environmental factors.
List the guidelines for cervical cancer screening.
Describe the initial management of a patient with abnormal cervical cancer screening, with
consideration of value-based care.
Describe the symptoms and physical findings of a patient with cervical cancer.
List current indications for HPV vaccination and its role in the prevention of cervical cancer.
EPAs covered: 1, 2, 3, 4, 7, 11
TEACHING CASE
A 46-year-old G1P1 patient (she/her/hers) is referred for the management of an abnormal cervical
cancer screening test showing High-Grade Squamous Intraepithelial Lesion (HGSIL) and positive highrisk HPV test. She has not received preventive care from either her PCP or ob-gyn since shortly after
she delivered her daughter 14 years ago until re-establishing care with her PCP recently. She reports
regular, monthly menses without menorrhagia or intermenstrual bleeding. She does not have any pain
or concerns. She is sexually active with a long-term male partner and has no sexual concerns or postcoital bleeding. She is on no medications and has no known drug allergies. Her family history is
notable for a grandmother with breast cancer. She smokes ½ pack of cigarettes per day, does clerical
work for a moving company, and lives with her daughter and her partner.
Copyright © 2021 by Association of Professors of Gynecology and Obstetrics (APGO)
For permissions: apgoadmin@apgo.org
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APGO MEDICAL STUDENT EDUCATIONAL OBJECTIVES, 11TH EDITION
Unit 5: Neoplasia
ET 52: Cervical Dysplasia and Neoplasia
COMPETENCY-BASED DISCUSSION & KEY TEACHING POINTS
Competencies addressed:
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Patient Care
Medical Knowledge
Systems-Based Practice
1. What risk factors does this patient have for cervical dysplasia? What are other possible risk factors
for development of cervical dysplasia?
2. What is meant by the term “high-grade squamous intraepithelial lesion”?
3. What is the next step in the evaluation of this patient’s abnormal cervical cancer screening test?
Copyright © 2021 by Association of Professors of Gynecology and Obstetrics (APGO)
For permissions: apgoadmin@apgo.org
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APGO MEDICAL STUDENT EDUCATIONAL OBJECTIVES, 11TH EDITION
Unit 5: Neoplasia
ET 52: Cervical Dysplasia and Neoplasia
4. What is the likelihood of this dysplasia progressing to cervical cancer? What is the typical time
course over which CIN 3 progresses to cervical cancer?
5. Given the histologic diagnosis of CIN 3, what is the appropriate next step for this patient?
REFERENCES
Perkins RB, Guido RS, Castle PE, Chelmow D, Einstein MH, Garcia F, et al. 2019 ASCCP risk-based management
consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. J Low Genit Tract Dis.
2020 Apr;24(2):102-131.
ACOG Practice Bulletin 140. Management of abnormal cervical cancer screening test results and cervical cancer
precursors. 2013, reaffirmed 2016. Available from: https://www.acog.org/clinical/clinical-guidance/practicebulletin/articles/2013/12/management-of-abnormal-cervical-cancer-screening-test-results-and-cervical-cancerprecursors
Copyright © 2021 by Association of Professors of Gynecology and Obstetrics (APGO)
For permissions: apgoadmin@apgo.org
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