B8.055 Cervical Cancer

Question 1

who do you test for HPV?

Answer 1

women > 30

do not test before this because 60-80% of young people will have HPV, but will clear it before age 30

Question 2

what is the cervical cancer risk of a patient who is 55 and has not had a pap in 10 years

Answer 2

higher risk than general population

Question 3

relationship between HPV prevalence and cervical cancer incidence

Answer 3

high risk HPV types prevalent in those 15-29, and decreases with age
risk of cervical cancer increases with age

Question 4

cervical cancer epidemiology

Answer 4

was once the leading cause of cancer death of women in the US, now is the most preventable of all female cancers
worldwide, 4th most common cancer in women
in US, not in top 10

Question 5

age rage of those affected by cervical cancer

Answer 5

37% of cervical cancers occur in women who are 20-44

-24% between 35 and 44 (peak)

Question 6

symptoms of cervical cancer

Answer 6

abnormal discharge (foul smelling)
abnormal, irregular vaginal bleeding
postcoital bleeding
pain during intercourse
post menopausal bleeding
pelvic, back or leg pain
cachexia

Question 7

why can you get back or leg pain with cervical cancer?

Answer 7

locally advanced disease can grow to encapsulate the sciatic nerve and block the ureters

Question 8

appearance of cervical cancer on speculum exam

Answer 8

fungating, exophytic, bloody

no normal cervix left in advance stages

Question 9

why is bleeding one of the main symptoms of cervical cancer

Answer 9

abnormal blood vessels coat the surface of the tumor

Question 10

treatment options for stage IA1 cervical cancer

Answer 10

cold knife cone (just cut out a specific area)

simple hysterectomy

Question 11

treatment options for stage IA2- IB cervical cancer

Answer 11

radical hysterectomy
radiation
equivalent survival in these two methods

Question 12

what is a radical hysterectomy

Answer 12

very wide margins

have to dissect out ureters, cut deep into posterior culdesac and bladder, and take upper 1/3 of the vagina

Question 13

treatment options for stage bulky IB, IIA-IVA cervical cancer

Answer 13

radiation with concomitant chemo (cisplatin)

Question 14

treatment options for stage IVB (metastatic) cervical cancer

Answer 14

chemo +/- bevacizumab (monoclonal ab against vegf)

Question 15

how does cervical cancer typically spread

Answer 15

usually spreads locally, destroys tissue around it

very uncommonly can spread through lymphatics and hematogenously

Question 16

stage IA

Answer 16

invasive carcinoma which can be diagnosed only by microscopy

Question 17

stage IB

Answer 17

clinically visible lesions limited to the cervix uteri or pre-clinical cancer greater than stage IA

Question 18

stage II

Answer 18

cervical cancer that invades beyond the uterus, but not to the pelvic wall or to the lower third of the vagina

Question 19

stage III

Answer 19

tumor extends to the pelvic wall and.or involves lower third of the vagina and/or causes hydronephrosis or non-functioning kidney

Question 20

stage IV

Answer 20

extension beyond true pelvis into bladder or rectum

Question 21

process of cervical cancer screening

Answer 21

scrape a portion of the external cervix and internal cervical os
look at cytology for abnormalities
test for HPV in those > 30

Question 22

why is cervical cancer incidence plateauing in the US

Answer 22

people who need to be screened aren’t being screened

-those who are often in the highest risk groups

Question 23

what are risk factors for cervical dysplasia

Answer 23

immunosuppression
HIV
transplant

Question 24

cofactors for invasive carcinoma

Answer 24

tobacco
OCPs
estrogen
other STDs

Question 25

HPV oncoproteins

Answer 25

E6
E7
responsible for malignant transformations

Question 26

function of E7

Answer 26

inactivates pRB (a tumor suppressor)

Question 27

function of E6

Answer 27

induces proteolytic degradation of p53

Question 28

appearance of HPV infected cells on histo

Answer 28

koilocytes

inflammatory cell infiltrate

Question 29

how long does CIN take to turn into cervical cancer typically

Answer 29

10 years

Question 30

describe the structure of HPV prophylactic vaccines

Answer 30

recombinant L1 capsid protein that form “virus like” particles
resemble native HPV particles
type specific
non-infectious and non-oncogenic, contain no DNA
produce higher levels of neutralizing Ab than natural infection

Question 31

when should preteens start/ finish the HPV vaccine series AND who else should get it

Answer 31

can start at age 9
should finish the series by their 13th bday
+ girls 13-26 who havent started or finished the series
+ boys 13-21 who havent started for finished the series

Question 32

which 3 vaccines can be given together to preteens

Answer 32

meningitis
HPV cancers
pertussis