Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Gynaeoncology > Cervical > Flashcards

Cervical Flashcards

1
Q

HPV % Cervical Cancer

A

99.7% of all cervical cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

High Risk HPV Strains

A

16 and 18 –> 70% of cervical cancer
6 and 11 –> genital warts (non-oncogenic)
31, 33, 45, 52 and 58 –> 19% of cervical cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Other Cancers Associated with Oncogenic HPV

A 
Vulva
 Vagina
Penis
 Anus 
Head and neck cancers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

HPV Vaccine Structure

A

Virus like proteins, DO NOT contain live, attenuated or killed virus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Gardasil 9

A

contains all of the above list strains (6, 11, 16, 18, 31, 33, 45, 52, 58), therefore potentially prevents 90% cervical cancers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

NZ HPV Vaccination Program

A
  • Implemented in NZ 2008

Routine school based vaccinations in 1st year of high school (age 12-13) boys and girls

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Funded Gardasil 9

A

Age 9 -27 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Dosing Gardasil 9

A
  • 2x doses given by IM injection at 0 and 5-13 months

- If >15yo or immunocompromised then recommend 3x doses: 0, 2 and 6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Gardasil 9 Efficacy

A

Gardasil 9 efficacy 97%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Testing for HrHPV

A

esting for high risk HPV has a strong negative predictive value (99%)

	§ Advantages:
		§ Better sensitivity of CIN2/3
		§ Higher negative predictive value of a negative test
		§ Avoids unnecessary interventions
	§ This can be done only on liquid based cytology
	§ Useful for LSIL/ASCUS >30yo --> if positive refer for colp, if negative then repeat in 12months
	§ Also useful for follow up:
		§ Following treatment for CIN2/3 doe HrHPV at 12month cytology
			□ Continue annually until both cytology and hrHPV are negative on 2 consecutive samples, then can be routine 3 yearly
			□ hrHPV takes 12months to clear so no point doing it sooner after treatment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

NZ Cervical Screening Population

A

Women age 20-69yo who have ever been sexually active

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Frequency of Cervical Screening

A

3yearly unless

  • first smear : repeat 1 year
  • last smear >5y ago : repeat 1 year
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Cervical Screening in NZ

A

50% who die from cervical Ca never been screened
In NZ since 1990 , rates reduced by 60%
Gap between Maori and non Maori

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Cervical Screening Post Hysterectomy

A

Women who need smears after hysterectomy:

- If the hysterectomy was subtotal
- If the hysterectomy was for CIN 2/3/ACIS and complete excision (need annual vault smear for 5 years then routine 3yrly)
- If previous CIN/2/3 on smears previous treated and normalised probably due routine vault smears
- If previous invasive gynaecological malignancy (at discretion of gynaeoncologist)
- If previous VAIN (1-2yearly smears)
- If immunosuppressed - routine 3yearly vault smears
- DES exposure - 1-2yearly vault smear and vaginal wall palpation - If smear history is not known then take smear at time of hysterectomy and if normal then no smears needed.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

WHO Principles of Screening

A
  1. The condition should be an important health problem
    1. There should be a treatment for the condition
    2. Facilities for diagnosis and treatment should be available.
    3. There should be a latent phase of the disease
    4. There should be a test or examination for the condition
    5. The test should be acceptable to the population
    6. The natural history of the disease should be well understood
    7. There should be an agreed policy on who to treat
    8. The total cost of finding a case should be economically balanced with medical expenditure as a whole
      Case-finding should be a continuous process not a once and for all project.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Staging

A

Stage I to IV

Subgrouped

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Stage I

A

The carcinoma is strictly confined to the cervix (extension to the uterine corpus should be disregarded)

18
Q

Stage IA

A

IA

Invasive carcinoma that can be diagnosed only by microscopy, with maximum depth of invasion <5mm

IA1

Measured stromal invasion <3mm in depth

IA2

Measured stromal invasion ≥3mm and <5mm in depth

19
Q

Stage IB

A

IB

Invasive carcinoma with measured deepest invasion ≥5mm (greater than Stage IA), lesion limited to the cervix uteri

IB1

Invasive carcinoma ≥5mm depth of stromal invasion, and <2cm in greatest dimension

IB2

Invasive carcinoma ≥2cm and <4cm in greatest dimension

IB3

Invasive carcinoma ≥4cm in greatest dimension

20
Q

Stage II

A

The carcinoma invades beyond the uterus, but has not extended onto the lower third of the vagina or to the pelvic wall

21
Q

Stage IIA

A

IIA

Involvement limited to the upper two‐thirds of the vagina without parametrial involvement

IIA1

Invasive carcinoma <4cm in greatest dimension

IIA2

Invasive carcinoma ≥4cm in greatest dimension

22
Q

Stage IIB

A

IIB

With parametrial involvement but not up to the pelvic wall

23
Q

Stage III

A

The carcinoma involves the lower third of the vagina and/or extends to the pelvic wall and/or causes hydronephrosis or nonfunctioning kidney and/or involves pelvic and/or para‐aortic lymph node

24
Q

Stage IIIA

A

The carcinoma involves the lower third of the vagina, with no extension to the pelvic wall

25
Q

Stage IIIB

A

Extension to the pelvic wall and/or hydronephrosis or nonfunctioning kidney (unless known to be due to another cause)

26
Q

Stage IIIC

A

IIIC

Involvement of pelvic and/or para‐aortic lymph nodes, irrespective of tumor size and extent (with r and p notations)c

IIIC1

Pelvic lymph node metastasis only

IIIC2

Para‐aortic lymph node metastasis

27
Q

Stage IV

A

The carcinoma has extended beyond the true pelvis or has involved (biopsy proven) the mucosa of the bladder or rectum. (A bullous edema, as such, does not permit a case to be allotted to Stage IV)

28
Q

Stage IVA

A

Spread to adjacent pelvic organs

29
Q

Stage IVB

A

Spread to distant organs

30
Q

Histopathologic Types

A
  1. Squamous cell carcinoma (keratinizing; non‐keratinizing; papillary, basaloid, warty, verrucous, squamotransitional, lymphoepithelioma‐like)
    1. Adenocarcinoma (endocervical; mucinous, villoglandular, endometrioid)
    2. Clear cell adenocarcinoma
    3. Serous carcinoma
    4. Adenosquamous carcinoma
    5. Glassy cell carcinoma
    6. Adenoid cystic carcinoma
    7. Adenoid basal carcinoma
    8. Small cell carcinoma
  2. Undifferentiated carcinoma
31
Q

Histopathological Grades

A

GX: Grade cannot be assessed
G1: Well differentiated
G2: Moderately differentiated
G3: Poorly or undifferentiated

32
Q

Stages of Cervical Cancer Development

A
  1. Oncogenic HPV infection of the metaplastic epithelium of the transformation zone
    2. Persistence of HPV infection
    3. Progression of a clone of epithelial cells from persistent viral infection to pre-cancer
  2. Development of carcinoma and invasion through the basement membrane
33
Q

Histologic % of Cervical Cancer

A
  • Squamous cell carcinoma 69%
    • Adenocarcinoma 25%
    • Other 6%
      ○ (clear cell, serous, adenosquamous, adenoid, small cell…)
34
Q

Lymphatic Drainage

A 
○ External iliac (43%)
		○ Obturator  (26%)
		○ Parametrial (21%)
		○ Common iliac
		○ Presacral
○Para-aortic
35
Q

Treatment Stage IA1

A

Cone or LLETZ with adequate margin, or simple hysterectomy

36
Q

Treatment Stage IA2 to IB1

A

Cone + lymphadenectomy or simple hysterectomy + LND (if fertility not desired). Traditionally managed with radical hysterectomy and LND

37
Q

Treatment Stage IB2

A

Radical hysterectomy + PLND + Combined chemo and radical radiation therapy (external beam and brachytherapy)
–> Or experimental fertility sparing is neoadjuvant chemo + Cone

38
Q

Treatment Stage IB3 - IVA

A

Radical Hysterectomy + combined chemo and radiotherapy

39
Q

Treatment Stage IVB

A

Chemo +/- antiangiogenesis agent (Abastin/bevacizumab)

*NB no rad hyst for stage above IVA

40
Q

Simple Hysterectomy

A

Indication- 1A1-1B1

Uterus and cervix- Removed

Vaginal margin- none

Ureters-Not mobilised

Cardinal ligaments- Divided at uterine and cervical border

Uterosacral ligament-Divided at cervical border

Bladder-Divided to base of bladder

Rectum- Not mobilised

Surgical approach-Any

41
Q

Radical Hysterectomy

A

Indication - 1B2 -4A

Uterus and cervix - Removed

Vaginal margin - Upper 1/4 to 1/3

Ureters - Tunnelled through broad ligament

Cardinal Ligaments- Divided at pelvic side wall

Uterosacral Ligaments - Divided at sacral origin

Bladder - Mobilised to mid vagina

Rectum- Mobilised below the cervix

Approach - Any

Gynaeoncology (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions