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OB/GYN Boards by Subject > Cervical cancer > Flashcards

Cervical cancer Flashcards

1
Q

Cervical cancer, percentage of total female cancers

A

13% of gyn cancers

4% when including breast cancer

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2
Q

Risk factors for cervical disease

A
  1. Sexual activity (includes HPV infection)
  2. Immune deficiency (HIV, steroids, smoking)
  3. Poor screening
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3
Q

Usual presentation of early cervical cancer

A

Abnormal screening

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4
Q

Progression of squamocolumnar junction over time

A

Recedes into endocervix

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5
Q

Endocervix cell types

A

Columnar

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6
Q

Ectocervix cell types

A

Squamous

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7
Q

Alternative HPV testing guideline for paps

A

HPV alone every 5 years starting at 25 y/o

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8
Q

When to discontinue pap screening

A

65 y/o IF no hx of CIN2-3 in last 20 years, no hx of cervix cancer, no DES

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9
Q

Koilocytosis is pathognomonic for ___

A

LSIL

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10
Q

Proportion of cervical cancer caused by HPV 16/18

A

70%

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11
Q

Low-risk HPV associated with condyloma and CIN1

A

HPV 6/11

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12
Q

Duration of HPV infection

A

Median 8 mos
70% resolve by 12 mos
>90% resolve by 24 mos

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13
Q

Progression of HPV to invasive cancer takes how long?

A

10-20 yrs

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14
Q

Advantage to HPV primary screening

A

Sensitive (good NPV), improve detection of glandular cell abnormalities

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15
Q

Disadvantage to HPV primary screening

A

Low specificity (low PPV), increased referrals for colpo

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16
Q

Trial that made HPV primary testing more acceptable

A

ATHENA

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17
Q

Acetowhite epithelium is ___

A

Intracellular keratin

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18
Q

How Lugol’s works

A

Stains glycogen brown in normal cells

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19
Q

What Lugol’s shows better

A

Vessels

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20
Q

Dysplasia development histologically

A

Starts at the basement membrane and makes its way to the epithelial surface (CIN1 is one layer at membrane and CIN is almost to surface (CIS includes epithelium)

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21
Q

Indications for ECC

A

Inadequate colpo, concern for endocervical extension

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22
Q

Cure rate of conization (LEEP, CKC, laser cone)

A

95%

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23
Q

When not to do laser ablation or cryotherapy

A

If colpo unsatisfactory

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24
Q

When to do conization

A

CIN 2-3 or high-grade screen with low-grade histology

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25
Q

Outcomes from positive margins following excision

A

67% resolve spontaneously

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26
Q

Management for positive margins following excision

A

Pap + ECC in 6 mos (then repeat excision if CIN 2-3) OR just repeat excision in 6 wks (preferred only for AIS)

27
Q

What if CIN1 persists beyond 2 yrs?

A

Continue follow-up vs excision

28
Q

At what age does endometrial cells on pap matter?

A

40 y/o

29
Q

What to do if premenopausal with endometrial cells on pap?

A

Asymptomatic > routine follow-up

Symptomatic > endometrial sampling

30
Q

What to do if postmenopausal with endometrial cells on pap?

A

Endometrial sampling regardless of symptoms

31
Q

What to do for AGC

A

HPV test, colpo, and ECC; add endometrial sampling if >35 y/o or risk factors

32
Q

What to do for atypical endometrial cells

A

HPV test, colpo, ECC, endometrial sampling

33
Q

What to do if AGC or AIS and no e/o invasive disease

A

Excisional procedure

34
Q

What to do if AIS on excisional procedure

A

Hysterectomy vs cautious observation if fertility desired

35
Q

LEEP during pregnancy?

A

Acceptable for CIN3 vs waiting till 6 wks postpartum

36
Q

When to start screening for HIV pos

A

Within one year of starting sexual activity

37
Q

When to stop screening for HIV pos

A

Never

38
Q

What is more common in HIV with CD4<500?

A

Glandular cell abnormalities

39
Q

Conization should be done before hysterectomy in setting of CIN IF…

A

Unsatisfactory colpo
Suspicion for cancer
ECC w/ CIN2-3
Evidence of high-grade glandular neoplasia

40
Q

Proportions of squamous vs adenocarcinoma of cervix

A

Squamous 70%

Adeno 20-25%

41
Q

Tools for FIGO staging of cervical cancer

A

EUA, cystoscopy, proctoscopy, IVP, CXR (or may substitute CT or PET)

42
Q

Mnemonic for cervical cancer staging

A

Down and out

43
Q

FIGO stage I-IV locations

A

I - cervix
II - uterus / upper vagina
III - lower vagina / pelvic sidewall
IV - outside of pelvis

44
Q

Survival rates by staging

A

I - 90%
II - 70%
III - 40%
IV - 15%

45
Q

Stage I divisions

A 
IA1 - <3 mm
IA2 <5 mm
IB1 >5 mm and <2 cm wide
IB2 >5 mm and 2-4 cm wide
IB3 >5 mm and > 4 cm wide
46
Q

Stage II divisions

A

IIA1 - upper 2/3 vagina, <4 cm
IIA2 - upper 2/3 vagina, >4 cm
IIB - parametrial involvement

47
Q

Stage III divisions

A

IIIA - lower 1/3 of vagina
IIIB - pelvic sidewall
IIIC1 - pelvic LN
IIIC2 - paraortic LN

48
Q

Stage IV divisions

A

IVA - adjacent organs

IVB - distant spread

49
Q

Treatment for IA1

A

Hysterectomy

50
Q

Treatment for IA2

A

Modified radical hysterectomy + PLND

51
Q

Treatment for IB1

A

Rad hysterectomy + PLND

52
Q

Treatment for IB2 and above

A

Chemo-RT + brachytherapy

53
Q

Most common early complications of radical hysterectomy

A

UTI, ileus, fever, DVT

54
Q

Most common late complications of radical hysterectomy

A

Urinary retention, lymphedema, sexual dysfunction

55
Q

When to use radiation as adjuvant therapy

A

Positive LN at time of surgery, risk factors like large tumor, deep invasion, parametrial extension, positive margins

56
Q

How chemoradiation works

A

Low-dose chemo sensitizes cells to radiation

57
Q

Management of acute bleeding in cervical cancer

A

Vaginal packing with Monsel’s
Embolization
“Hot shot” or traditional brachytherapy

58
Q

How to treat cervical cancer at 24 wga or above

A

Consider neoadjuvant chemotherapy

Deliver by Classical C/S

59
Q

How to treat cervical cancer <24 wks and no desire to continue pregnancy

A

Stage I-IIA: rad hyst + LND

Stage IIB - IVA: pelvic chemo-RT, SAB vs D&E, brachytherapy

60
Q

Surveillance post-treatment for cervical cancer

A

Every 3 months x 2 yrs
Every 6 mo to 5 yrs
Annually after that

61
Q

What to do for vaginal bleeding after radiation treatment for cervical cancer

A

Colpo, pack with Monsel’s, embolization, hysterectomy (last resort because risk for complications)

62
Q

Treatment for central recurrence

A 
Radiation (if s/p rad hyst)
Pelvic exenteration (if s/p radiation)
63
Q

Treatment for lateralized pelvic recurrence

A

Chemo-RT (if s/p rad hyst)

Chemo (if s/p radiation)

64
Q

Treatment for distant recurrence

A

Systemic chemo

OB/GYN Boards by Subject (22 decks)

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