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Clin Med III > cervical abnormalities > Flashcards

cervical abnormalities Flashcards

1
Q

what are the classifications for cervical intraepithelial neoplasia (CIN)?

A
  • CIN1- equivalent to LSIS
  • CIN2- if p16 neg then LSIS, if p16 pos then HSIS
  • CIN3- equivalent to HSIS
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2
Q

pathogenesis of CIN

A
  • 99% from HPV d/t sexual contact
  • older age= less likely to clear infection
  • longer the infection persists= longer it takes to clear
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3
Q

what is the transformatino zone

A
  • site of carcinogenesis by infx of HPV
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4
Q

what type of cells are found in ectocervix

A
  • squamous cells
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5
Q

what type of cells are found in endocervix

A
  • columnar
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6
Q

what are the low risk HPV variants

A
  • HPV 6

- HPV 11

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7
Q

what are the high risk HPV variants

A
  • HPV 16

- HPV 18

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8
Q

latent HPV infection

A
  • without manifestations

- HPV DNA just in cytoplasm

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9
Q

active HPV infection

A
  • HPV undergoes replication
  • NOT integrated into genome
  • DNA just in cytoplasm
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10
Q

neoplastic HPV transformation

A
  • DNA gets integrated into host genome
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11
Q

cofactors in HPV pathogenesis

A
  • immunosuppression
  • cigarette smoking
  • herpes, chlamydia
  • OCPs
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12
Q

what is HPV cotesting

A
  • perform pap and HPV testing at the same time
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13
Q

what is HPV reflex testing

A
  • aka triage

- HPV test only if cytology shows ASC-US

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14
Q

how is HPV prevented

A
  • vaccine

- usually gardasil 9

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15
Q

ages of female HPV vaccination

A
  • 9-26
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16
Q

ages of male HPV vaccination

A
  • 9-21

- can vaccinate up to 26 if MSM or immunocompromised

17
Q

what are the subtypes of atypical cervical squamous cell abnormalities

A
  • ASC-US (undetermined significance)

- ASC-H (cannot exclude high grade lesion)

18
Q

invasive cervical cancer risk factors

A
  • early onset sexual activity
  • multiple partners
  • high risk sexual partners
  • hx of STI
  • hx of VIN or cancer
  • immunosuppression
19
Q

how does cervical cancer spread

A
  • lymphatic spread

- direct extension to adjacent pelvic organs

20
Q

clinical manifestations of cervical cancer

A
  • irregular or heavy bleeding

- post-coital bleeding*

21
Q

what is included in the clinical staging of cervical caner

A
  • PE
  • cervical bx
  • endoscopy
  • imaging- PET is best
22
Q

what LN are most important to assess in cervical cancer

A
  • pelvic

- paraaortic

23
Q

cervical cancer in pregnancy

A
  • same prognosis as non-pregnant women
  • ASC-US -> colposcopy 6 weeks pp
  • ASC-H -> colposcopy with hx
  • curettage c/i
24
Q

why are pap smears used

A
  • reduce mortality from cervical cancer by 80%
25
Q

what is the traditional/ conventional method of pap

A
  • smear samples on a slide

- slide fixed with preservative

26
Q

what is the thin-prep method of pap

A
  • cells from sample released into vial of liquid

- lab produces slides

27
Q

when should pap smears be started and stopped?

A
  • start at 21

- stop at 65 if no recent abnormal pap

28
Q

how often do you get a pap if ages 21-29

A
  • every 3 years
29
Q

how often do you get a pap if over 30 years old

A
  • choose one of the following methods:
  • pap every 3 years
  • hrHPV testing q 5 years
  • cotesting q 5 years
30
Q

what is the tx for HSIL

A
  • excision and ablation of transformation zone
31
Q

what is the tx for recurrent CIN

A
  • hysterectomy
32
Q

what are the excisional treatment options

A
  • cone biopsy/ cervical conization
  • LEEP
  • laser conization
33
Q

what are the ablative therapy options

A
  • cyrotherapy

- laser

34
Q

management of ASC-US in ages 21-24

A
  • repeat pap in 12 mo
  • if cytology is neg, ASC-US, or LSIL then repeat pap yearly for 2 years
  • if cytology is ASC-H, HSIL, or AGC then get colposcopy
35
Q

management of ASC-US in ages 25+

A
  • get reflex testing
  • if HPV neg and ASC-US do cotesting in 3 years
  • if HPV pos and ASC-US get colposcopy
36
Q

management of ASC-H in ages 21-24

A
  • cytology and colposcopy q 6 mo for 12 mo
  • if abnormally persists for 1 year -> repeat bx
  • if abnormally persists for 2 years -> treat
37
Q

management of ASC-H in ages 25+

A
  • get colposcopy
  • if n CIN1 then cotest in 12 and 24 months, coloposcopy if abnormal result
  • if CIN 2 or 3 treat
38
Q

management of CIN1

A
  • follow up required
  • if persists for 2 years then f/u or treat
  • if CIN 2 or 3 then treat
39
Q

management of CIN 2 or 3

A
  • treatment required

Clin Med III (26 decks)

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