cervical Flashcards
what virus and 4 types linked to cervical neoplasia
HPV 16, 18, 31, 33
2 HPV types linked to condylomata acuminata
HPV 6 and 11. mainly 11
early age sex, early childbearing, blacks, smoking, multiple sex partners, STD hx, low socialeconomic status
cofactors in cervical cancer
what part of cervix is 95% of cancer involved
transformation zone
what percentage of CIN-3 develop microinvasive and frankly invasive carcinoma
1/3
CIN age, CIS age, cervical cancer age
CIN 20s, CIS 25-35 y/o, cervical cancer after age 40
HPV 16, 18, 31, 33
virus and 4 types linked to cervical neoplasia
HPV 6 and 11
2 HPV types linked to condylomata acuminata; mainly 11
HPV most prevalent in squamous cell and adenocarcinoma
squamous: HPV 16
adenocarcinoma: HPV 18
gardasil vaccine protects against what types; ages of boys/girls
6, 11(90% of warts), 16, 18(70% cervical cancer). given up to age 26
boys 11-12 and girls 9-26; 3 injections over 6 months
which HPV causes 70% of cervical cancer
18
what decreases the risk of cervical/vaginal cancer
use of condoms or diaphragm
what is neoplasia
abnormal growth of cells
what is dysplasia
abnormal development of typically with an excess of immature cells
when to start screening
within 3 years of becoming sexually active OR reaching age 21
2 initial tests to get for cervical carcinoma
colposcopy with biopsy; and HPV DNA
CIN-1, CIN-2, CIN-3, CIS definitions
what percentage of CIN-3 progress to CIS
CIN-1: mild cervical intraepithelial neoplasia
CIN-2: moderate cervical intraepithelial neoplasia
CIN-3: severe cervical intraepithelial neoplasia
CIS: carcinoma in situ
what percentage of CIN-3 progress to CIS: 1/3
2 steps in the colposcopy
- schiller test
- paint the cervix with Lugol’s iodine. Cells that do not stain should be biopsied
3 aspects of the cervical biopsy
- punch biopsy
- endocervical curettage
- conization for CIN-3 and CIS. Removing the entire transformation zone
how to treat pre-invasive CIN
conization
how to treat advanced cervical disease
hysterectomy with pelvic lymphadenopathy
conization can lead to what
incompetent cervix than a LEEP
common signs of cervical cancer
metrorrhagia, postcoital spotting, cervical ulceration
what sign may appear after cancer invasion
bloody or purulent, malodorous, non-pruritic discharge
cervical cancer screening
21-29 y.o
30-65 y.o
over 65 y.o
cervical cancer screening
21-29 y.o: every 3 years Pap smear(cytology)
30-65 y.o: every 3 years Pap smear or every 5 years perform co-testing with pap+HPV
over 65 y.o: stop screening if all tests are neg
definitions ASC-US ASC-H LSIL AGC HSIL
ASC-US: atypical squamous cells of undetermined significance
ASC-H: atypical squamous cells
LSIL: low grade intraepithelial lesion
AGC: atypical glandular cells of undetermined significance
HSIL: high grade squamous intraepithelial lesion
DES exposure risk for what
clear cell cancer
subtype for: benign with inflammation CIN I CIN II CIN III
benign with inflammation: ASC-US and ASC-H
CIN I: LSIL
CIN II: HSIL
CIN III: HSIL
4 common infectious cervicitis organisms; most common
**chlamydia, gonococcus, trichomonas, HSV
mucopurulent cervicitis
chlamydia more common than gonococcus
3 non infectious causes for cervicitis
trauma, radiation exposure, malignancy
exam for cervicitis (3)
yellow green mucopurulent discharge, + cervical motion tenderness, friable cervix
yellow green mucopurulent discharge, + cervical motion tenderness
cervicitis
test for cervicitis
gram stain. chlamydia and gonorrhorea make up 40% of cases.
cervicitis tx
chlamydia: azith 1 gm PO dose plus doxy 100mg po BID for 7 days
neisseria: ceftriazone 250mg IM plus azith 1 gm PO
2 studies for cervical incompetence
bimanual physical exam and vaginal ultrasound
cervical incompetence tx
surgical cerclage: using suture to reinforce cervix
yellow green mucopurulent discharge, + cervical motion tenderness, friable cervix
cervicitis
