cervical CA Flashcards
what HPV infx are linked to cervical neoplasia?
16, 18, 31, 33
- 80% of cervical intraepithelial neoplasia (CIN) lesions and 90% of invasive cervical carcinomas show the presence of HPV
what are types 6 and 11 linked to?
condylomata acuminata
what are other RF that may cause the development of cervical intraepithemlia neoplasia lesions?
early age at first intercourse, early childbearing, mul sex partners, hx of STI, low socioeconomic status, AA, smoking
what part of the cervix may show/initiate cervical ca
transformation zone! involved in 95% of the cases
what is mild dysplasia?
CIN-1 and may progress to moderate (CIN2) severr (CIN3), and carinoma in situ; it can also stay the same or regress
how many pts w/ CIN 3 may develop microinvasive and invasive carcinoma?
1/3
what age group showl CIN
women in their 20s
what age group may solw CIS?
25-35 yo
cervical cancer age group?
> 40
Clinical Features of cervical dyplasia?
no sx, advanced or invasive may cause abnormal vag bleeding and vag discharge, tumor
what is the mean age of dx ?
47, but 39 in lower sE status groups
what other PE findings might you see?
enlargment of the cervix- endophytic spread: “barrel” shaped cervix
exophytic- friable, fungating lesion
- ulceration: starts superficial, becomes deeper and encrotic as dz progresses
- nodularity of uterosacral ligaments
types of cervical cancer
squamous cell carcinoma
adenocarcinoma, adenosquamous carcinoma
features of squamous cell?
HPV 16, most common
90% develop from intraepithelial layers
typically w/ in 1 cm of squamocolumnar junx
-large cell nonkeratinizeing
types of squmous cell
verrucous- HPV 6 (more slowley growing and locally invasive, looks like condyloma
-large cell keratinizing or small cell
ADenocarcinoma
HPV 18 most prevalent,
dervived from glandular elements
women under age 35
increased incidence over lasat several decades (screening and prevention of squmous lesions)
where types of adenocarcinomas are there?
-mucinous, edometrioid, clear cell, serous
what is clear cell related to?
utero DES (diethylstilbestrol) exposure- drug used to prevent miscarriage
what is the worst type of cervical cancer?
neuroendocrine carcinoma!
most aggressive, survival is < 50% even in early stage, widespread hematogenous metastases are frequent
dx of cervical cancer
, liquid-based specimen, and other cytologic screening techniques are highly effective and should begin within 3 years of becoming sexually active or reaching age 21 (whichever comes first). Annual pap smear reduces incidence of invasive cervical carcinoma by 95% (BUT – now new guidelines
can you stop screening for cervical cancer after a hysterectomy?
yes!
who must get an annual screening?
the immunocompromised!
what if the results are abnormal?
o Biopsy of suspicious lesions is mandatory
o Colposcopy with biopsies is the most appropriate technique for histologic evaluation
o Conization is used when the results of colposcopy are unsatisfactory or endocervical curettage scrapings indicate severe disease
BEthesda Criteria?
ASC-US, ASC-H, LSIL, HSIL
ASC-US
atypical squamous cell of undetermined significance
AS-H
atypical squamous cells, high grade lesion cannot be excluded
LSIL
low-grade squamous intraepithelial lesion
HSIL
high-grade squamous intraepithelial lesion
treament of CCA
mild lesions- may resolve spontaneously
-
preinvasive neoplasia tx
electrocautery or cryocautery, laser therapy, conization, large-loop excision of transitional zone, or loop electrodiathermy excision procedure (LEEP
severe abnormalilty tx?
o Hysterectomy and pelvic lymphadenectomy or radiation therapy i
gardasil vaccine?
HPV associated with cervical cancer. CDC recommends all girls aged 11-12 years receive series of 3 injections over 6 months (but it is available to all women 9-26 years old). Prevent 4 types of HPV in those not previously exposed. May need boosters every 5 years
