Benign & Neoplastic Cervical & Uterine Abnormalities Flashcards
pt. p/w:
a. Translucent or yellow cyst
b. Millimeters to 3 cm
c. Usually asxs
Found on speculum exam
nabothian cysts
Tx for nabothian cysts…
nothing
pt. p/w:
a. < 3cm polyp
b. Post-coital bleeding
c. AUB
Found on speculum exam
Cervical Polyps
tx for cervical polyps
polypectomy if sxs
The region of cervix composed of squamous exocervix and columnar endocervical epithelium…
transformation zone
An adequate pap smear requires a sample from what cells of the cervix?
endocervical
Where does HPV enter?
breaks in the transformation zone
Type 16 HPV is associated with _____
Type 18 HPV is associated with _______
16 = SCC
18 = adenocarcinoma (columnar)
the below are RFs for…
a. Multiple sexual partners
b. Early sexual activity
c. Hx of STI
d. Smoking/Immunosuppression
e. Long-term COC use
f. Multiparity
HPV
Gardasil protects against the ____ MC types of HPV
9
when performing HPV testing, it is important to differentiate between what two courses?
transient and persistent
2 positive HPV tests indicates a _____% chance of CIN II/III w/in 3 years
21%
When should Cervical CA screening be initiated despite onset of sexual activity?
21
the below describes the cervical CA screening regiment for what population??
a. HPV screen after initiation of intercourse
b. COC counseling
c. Gardasil
d. STI screen
adolescents
Do adolescents get a routine pap smear?
e. No pap unless high risk
nearly half of HPV cases occur in what age range?
15-24
any women up to the age of ___ should be vaccinated with gardisil
45 yo
Two components of a pap smear…
cytology (check for abnormal cells)
HPV DNA testing (age dependent)
Pap smear is performed as a screen for…
cervical CA
Why perform dual pap and HPV testing?
increased sensitivity (86.9%)
Does screening prior to 21 yo reduce rate of cervical CA?
no
Why no HPV testing in adolescent population?
they clear HPV quickly (no time for neoplastic change)
Do adolescents need a pelvic exam/pap smear for routine screening?
no
How should STI screen be conducted in adolescent population?
urine screen
Women 21-29 screening proptocol
pap smear only q 3 years
Women 30-64 screening protocol…
pap smear + HPV q 5 years
HIV+ screening protocol
at time of dx
q 6 mo x 1 year then q yearly
the below should receive pap smears at what frequency?
imunocompromised
hx of cervical CA
CIN II/III Hx
DES exposure
yearly
If the below characteristics are present, when can cervical CA screening stop?
3 negative cytology alone
2 negative combo
testing occurred w/in 5 years
no CIN 2+ w/in 20 years
65 yo
If a women over 65 reports a new sexual partner, does screening resume?
no
If hysterectomy with cervix removal, what two factors allow for cessation of cervical CA screening?
performed for benign dz
no CIN 2+ w/in 20 years
If on speculum exam you see a cervical lesion, what do you do?
No pap smear
Bx
What type of abnormal pap smear?
Can be HPV neg if:
- c. trachomatis
- HSV
- vulvovaginal atrophy
ASCUS
What type of abnormal pap smear?
CIN I lesions
Enlarged, hyperchromatic nuclei
abundant cytoplasm
LSIL
Why no HPV result with HSIL pap smear?
assume HPV presence
What What type of abnormal pap smear?
CIN II-III, AIS lesion
Enlarged, hyprechromatic nuclei
little/no cytoplasm
HSIL
(+) ASCUS or LSIL protocol if Age 21-24
repeat in 1 year
(+) HSIL protocol
colposcopy
What grade CIN?
a. Regression w. in 12 mo
b. Lower 1/3 of epithelial lining
CIN I
What grade CIN?
a. 43% of lesions regress, 35% persist, 22% progress
b. Lower 2/3 of epithelial lining
CIN II
What grade CIN?
a. 32% regress, 56% persist, 14% progress
b. > 2/3 epithelial lining
CIN III
What indicates a satisfactory colposcopy?
visualization of CTZ
Abnormal pap smear indicates what test?
colposcopy
If unsatisfactory colposcopy, what is performed?
endocervical curettage (ECC)
When wouldn’t you want to perform LEEP for abdnormal cervical lesions? (3)
invasion suspected
gland abnormality
pregnant
LEEP has a ___% cure rate
90-95
Tx of choice for abnormal cervical lesion…
LEEP
LEEP recovery takes ___ weeks
4
Cervical CA is the _____ MC GYN CA in the US
3rd
Which type of cervical CA?
MC
prevalence falling
3mm or less = micro
3+ mm or visible lesion = invasive
SCC
What type of cervical CA?
prevalence rising
Types: endocervical, endometriod, clear cell, adenoid cystic
cervical adenocarcinoma
Pt. p/w:
a. Abnormal vaginal bleeding
b. Pelvic pain + radiation to thigh = advanced disease
c. vaginal d/c
cervical CA
cervical CA is the only GYN CA that is _____ staged
clinically staged (rest are surgically staged)
To stage cervical CA, you must examine what other 3 tissues?
bladder, uterus, rectum
What imaging is indicated for cervical CA staging?
CXR/CT for thoracic involvement
MRI for extension
Pt. p/w:
a. AUB, Pain, Pelvic Pressure, Infertility
b. Spontaneous abortion
uterine fibroids
AUB is indicative of which kind of uterine fibroid?
submucosal
What imaging modality is helpful in visualization of size and location of submucosal uterine fibroids?
saline-infused sonohystogram
Depot Lupron does what to uterine fibroids?
decrease size, improve anemia
steroidal or lysteda treatments for fibroids don’t work for which type?
submucosal fibroids
Which uterine fibroid surgery?
i. Preserves fertility
ii. Intramural, subserosal, pedunculated fibroids
iii. must have c-section after surg.
myomectomy
Which uterine fibroid surgery?
i. Preserves fertility
ii. Only on submucosal
iii. outpatient
hysteroscopy
Which uterine fibroid surgery?
i. Must continue contraceptive
ii. But no future childbearing/doesn’t preserve fertility
iii. preserves uterus
iv. outpatient
endometrial ablation
Which uterine fibroid therapy?
i. preserves uterus, not fertility
ii. cuts blood supply to fibroid
iii. C/I numerous, large fibroids
iv. hospitalization
Uterine artery embolization
Pt. presents with:
a. Menorrhagia
b. Dysmenorrhea
c. Pelvic pain
d. Hx of uterine surgery
adenomyosis
Definitive tx and dx for adenomyosis
hysterectomy
symptomatic tx for adenomyosis…
contraceptives
Pt. p/w:
a. Premenstrual pelvic pain that subsides after menses
b. infertility
c. dysmenorrhea/dyspareunia
endometriosis
only way to Dx endometriosis…
laparascopy
ovaries, chocolate cysts
Tx of mild endometriosis
nsaids
tx for mod-severe endometriosis
OCPs
major RF for endometrial hyperplasia…
obesity
MC sxs of endometrial hyperplasia… (2)
oligomenorrhea
post-menopausal bleed
workup for endometrial hyperplasia
pelvic exam
pelvic exam
endometrial bx
endometrial thickness < 4mm… is that concerning?
no
When would you do D&C hysteroscopy for endometrial hyperplasia?
inconclusive EMB
Tx for endometrial hyperplasia w/o atypia… (3)
i. Mirena IUD
ii. Provera
iii. Reassess w. EMB
Tx for endometrial hyperplasia w/ atypia
- Hysterectomy
- Progesterone therapy
(high risk endometrial CA
Which type of endometrial CA?
i. Favorable prognosis, well differentiated tumors
ii. Adenocarcinoma: MC
iii. unopposed estrogen
Type I
Which type of endometrial CA?
a. Rare, not associated w. estrogen
b. Poor prognosis
c. poorly differentiated
Serous carcinoma
Which type of endometrial CA?
a. Rare, not associated w. estrogen
b. Poor prognosis
c. poorly differentiated
d. aggressive/high grade
clear cell carcinoma
MC sxs of endometrial CA (2)
post-menopausal bleed
AUB
Tx of endometrial CA…
a. Hysterectomy + bilateral salpingoophorectomy w. pelvic and periaortic lymphadenectomy
MC GYN CA?
endometrial CA
