Background

Question 1

What is the annual incidence of cervical cancer in the United States?

Answer 1

∼12,000 cases/yr of cervical cancer in the United States.

Question 2

What is the mean age of presentation for cervical cancer?

Answer 2

The mean age of presentation for cervical cancer is in the 40s in the United States.

Question 3

List the 7 lifestyle factors associated with an increased risk of cervical cancer.

Answer 3

Lifestyle factors associated with increased risk of cervical cancer:

Early onset of sexual activity
Larger number of sexual partners
Exposure to high-risk partners
Hx of STD
Smoking
High parity
Prolonged use of oral contraceptives

Question 4

HPV is detectable in what % of cervical cancer?

Answer 4

HPV is detectable in >99% of cervical cancer.

Question 5

Roughly what % reduction in mortality has been achieved with PAP screening for cervical cancer?

Answer 5

There has been an ∼70% reduction in cervical cancer mortality with PAP screening.

Question 6

What does ASCUS stand for (on a PAP result), and how should it be managed?

Answer 6

ASCUS stands for Atypical Squamous Cells of Unknown Significance. About two-thirds can resolve spontaneously. Pts can undergo repeat PAP in 6 mos and then colposcopy if abnl.

Question 7

How should LGSIL seen on PAP be managed?

Answer 7

LGSIL resolves spontaneously ∼40% of the time; therefore, like with ASCUS, pts can undergo repeat PAP in 6 mos with colposcopy if abnl.

Question 8

How should a HGSIL result from a PAP be managed?

Answer 8

All pts with HGSIL should undergo colposcopy with Bx. One-third of these pts can still resolve spontaneously, but waiting without further investigation is not recommended d/t concern for progression.

Question 9

What % of HGSIL progresses to invasive cancers?

Answer 9

22% of HGSIL progress to invasive cancer. This is in contrast to ASCUS (<1%) and LGSIL (∼5%).

Question 10

What % of cervical cancers are caused by HPV-16 and -18?

Answer 10

> 70% of cervical cancers are caused by HPV-16 and -18.

Question 11

What HPV subtypes cause the most cases of benign warts?

Answer 11

HPV subtypes 6 and 11 cause most cases of benign warts.

Question 12

What HPV subtypes do Cervarix and Gardasil 9 protect against, respectively?

Answer 12

Cervarix protects against HPV types 16 and 18. Gardasil 9 protects against HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58. This vaccine can be given to males and females of ages 9–26 yo to protect against cervical cancer, vulvar cancer, anal warts, and genital warts.

Question 13

In the United States, what % of cervical cancers are SCCs vs. adenocarcinomas?

Answer 13

With regard to cervical cancers in the United States, 80% are SCCs, while ∼20% are adenocarcinomas.

Question 14

List 5 histologic subtypes of adenocarcinoma of the cervix.

Answer 14

Subtypes of adenocarcinoma of the cervix:

Mucinous
Adenosquamous
Endometrioid
Clear cell
Glassy cell

Question 15

Name the 3 common presenting Sx of cervical cancer.

Answer 15

Most common presenting Sx of cervical cancer:

Abnl vaginal bleeding
Postcoital bleeding
Abnl vaginal discharge
Dyspareunia
Pelvic pain

Question 16

What specific area of the cervix is the most common point of origin for cervical cancer?

Answer 16

The transformation zone is the most common point of origin for cervical cancer. It is a dynamic area b/t the original and present squamocolumnar junction.