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Obstetrics And Gynecology > Cervical Cancer > Flashcards

Cervical Cancer Flashcards

1
Q

M/C cancer in women in India

A

Ca breast > Ca cervix

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2
Q

M/C genital cancer of women in India

A

Ca cervix

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3
Q

Most common cause of Ca Cervix

A

HPV - 99%

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4
Q

Screening method used for Ca cervix

A

Pap smear

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5
Q

Pap smear is taken from which area and Procedure

A

Done at transformation zone (area b/w endocervix and ectocervix) - then plate them on slide - fixed with 95% alcohol - solution passed through filter - Cells from transformational zone gets filtered

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6
Q

Instrument used for Pap smear

A

Ayre’s spatula
Also cytobrush and Cytobroom can be used - Liquid based Cytology

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7
Q

Sensitivity of Pap smear as screening method for Ca cervix

A

47-62%
Incidence has reduced by 75 to 80%
Death reduced by 70%

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8
Q

Most common type of HPV responsible for Ca cervix and Also most malignant HPV

A

M/C - HPV 16
Most malignant - HPV 18

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9
Q

Transformation zone means

A

Area between columnar epithelium and Squamous epithelium where columnar cells are converting constantly into Squamous cells

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10
Q

Transformation is how much cm away from external os

A

1.7 to 2.3cm

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11
Q

When to do Pap smear

A

For >21 years all women
In India, usually 3 years after begining of sexual activity
21-29 yrs : once in 3 years if Pap smear is negative

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12
Q

Risk factors of Ca Cervix

A

HIV 1 and 2
HSV 1 and 2
Commercial sexual workers
Partners with STDs
Multiparous women
Immunocompromised
Low socioeconomic status
Smokers
Early Intercourse (<16 yrs) - more exposure

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13
Q

Pap smear frequency after 30 yrs of age and other tests done

A

Once in 3 years if Pap smear is negative
Co Test - Pap + HPV DNA - once in 5 yrs

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14
Q

Pap smear after 65 yrs of age

A

Stop doing pap smear, specially if Last 3 pap smears are negative or 2 Co tests went negative

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15
Q

Stain used to see pap smear on microscope

A

Papanicolaou stain

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16
Q

Abnormal finding in Pap smear

A

Big nucleus
Reversal of nucleus cytoplasmic ratio

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17
Q

Dysplasia classification

A

If <1/3 Abnormal cells - Cervical inter epithelial Neoplasia 1 (CIN 1)
If >1/3 and <2/3 Abnormal cells - CIN 2
If >2/3 cells are Abnormal - CIN 3
If all cells are Abnormal - Carcinoma insitu

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18
Q

Bethesda classification

A

Low grade Squamous interepithelial lesion (LGSIL) - CIN 1
High grade Squamous interepithelial lesion (HGSIL) - CIN 2,3, Carcinoma insitu

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19
Q

CIN 1 can change into CIN 3 and CIN 3 to Ca cervix in how many years

A

CIN 1 to 3 - 5 years
CIN 3 to Ca cervix - 10 years

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20
Q

What to do if CIN 1 is +ve on Pap smear

A

CIN is not a precursor
Frequent pap smear once in 6 months
Antiviral or antibiotics
HPV DNA Assessment

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21
Q

Precursors of Ca Cervix

A

CIN 2 and 3

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22
Q

What to do if CIN 1 +ve for > 2 years

A

Continue surveillance or
Ablation/treatment

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23
Q

Which test need to do confirm CIN 3

A

Colposcopic Biopsy or
Can do visual inspection under Acetic acid or Lugol’s iodine

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24
Q

Colposcopic Biopsy procedure

A

Vaginal Examination under illumination and magnification
Can see if there is any abnormal area

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25
Q

Highlighters used in case of Colposcopic Biopsy to see abnormal areas and Findings

A

1) Acetic acid - Rapidly dividing areas will become white ij color (Acetowhite areas) - take sample
2) Schillers or Lugol iodine - Stains glycogen rich areas - become Mahogany’s brown color - sample is taken from unstained areas

26
Q

CIN 3 management if Biopsy finding shows some cells already invading into stroma of cervix

A

Invasive cancer cervix
Treatment - Radical Hysterectomy

27
Q

CIN 3 Management if Biopsy finding shows abnormal cells only in surface, no invasion

A

Biopsy Proven CIN 3
Management -1) Excision of transformation using a large loop AKA Loop electrosurgical excision procedure (LEEP)
2) Laser ablation - requires too much training, expensive
3) Cryocautery

28
Q

Management of CIN 3 for >35 yrs and >40 yrs patient

A

> 35 yrs - Conization
40 yrs - Hysterectomy

29
Q

Clinical features seen in Ca Cervix

A

Abnormal vaginal bleeding (M/C postcoital)
Dirty foul smelling discharge
Uremia
Pain
Pyometra (Pus in uterus) - M/C bcz of Ca Cervix
Post Menopausal bleeding
Cancer cachexia

30
Q

Diagnosis method used in case of GSIL/CIN 3, Post coital Bleeding or Carcinoma in situ

A

Colposcopic cervical Biopsy

31
Q

Management in case of Adenocarcinoma in situ of cervix

A

Hysterectomy

32
Q

Management in case of Vulval interepithelial neoplasia 3 (VIN 3)

A

Superficial excision or laser ablation

33
Q

Staging of Ca Cervix is done

A

Done clinically
Per speculum exam
Per vaginal exam
Per rectal exam
Cystoscopy
Proctoscopy
Imaging - USG, CT, MRI, PET CT

34
Q

Staging Of Ca Cervix

A

Stage 1 - Stage 1A (1A1 And 1A2) , Stage 1B (1B1, 1B2 And 1B3)
Stage 2 - Stage 2A (2A1, 2A2), Stage 2B
Stage 3 - Stage 3A, Stage 3B, Stage 3C (C1 and C2)
Stage 4 - Stage 4A, Stage 4B

35
Q

Stage 1 of Ca Cervix

A

Limited to Cervix
Stage 1A - Microscopic cancer, A1 - Depth <3mm, A2 - 3-5mm
Stage 1B - Macroscopic/Clinically obvious, B1 - <2cm, B2 - 2 to 4cm, B3 - >4cm

36
Q

Stage 2 of Ca cervix

A

Vaginal involvement
Stage 2A - Upper vagina, 2A1 - <4cm, 2A2 - >4cm
Stage 2B - Parametrial Involvement

37
Q

Stage 3 of Ca cervix

A

Stage 3 A - lower 1/3rd vagina
Stage 3B - Parametrial involved till pelvic sidewall - ureter might get compressed (Hydronephrosis)
Stage 3C - C1 - Pelvic LN involvement
C2 - Paraaortic LN involvement

38
Q

Stage 4 of Ca cervix

A

4A - Bowel and bladder involvement
4B - Distant metastasis

39
Q

Most common stage of presentation of Ca cervix in India

A

Stage 3B

40
Q

Which area of cervix is M/C involved in Ca cervix

A

Anterior lip of Cervix

41
Q

Radiotherapy can be done for which stages in case of Ca Cervix

A

Good for all stages

42
Q

Chemo radiation is provided in which stages of Ca Cervix

A

Stages >2B Or >2A2

43
Q

Treatment of Stage 1A1 without lymphovascular space invasion

A

Conization or Extrafascial Hysterectomy

44
Q

Treatment of Stage 1A1 With Lymphovascular space invasion

A

Radical Trachelectomy or Radical hysterectomy + Pelvic Lymphadenectomy or sentinel LN biopsy (Ext. Iliac LN > Obturator LN)

45
Q

Treatment of Stage 1A2 and 1B1

A

Stage 1A2 - >3mm <5mm
Stage 1B1 - >5mm <2cm
Radical Trachelectomy or Radical hysterectomy + Pelvic Lymphadenectomy or sentinel LN biopsy

46
Q

Treatment of Stage 1B2

A

> 2cm <4cm
Radical hysterectomy + Pelvic Lymphadenectomy

47
Q

Treatment of Stage 1B3

A

> 4cm
Chemo radiation

48
Q

Treatment of Stage 2A1

A

<4cm + upper vagina
Radical hysterectomy + Pelvic Lymphadenectomy or chemoradiation

49
Q

Treatment of Stage 2A2

A

> 4cm + upper vagina
Chemoradiation

50
Q

Most common histopathology form of Ca Cervix

A

Squamous cell carcinoma

51
Q

Histopathological variants of Ca cervix

A

Squamous cell carcinoma
Large cell keratising
Large cell non keratising
Small cell variant
Adenocarcinoma cervix

52
Q

M/C cause of death in Ca cervix

A

Uremia

53
Q

2nd and 3rd M/C cause of death in case of Ca Cervix

A

2nd M/C - Hemorrhage
3rd M/C - Infection

54
Q

Vaccine for prevention of Ca Cervix and Variants protected by them

A

Cervarix - 16,18
Gardasil - 6,11,16,18
Gardasil 9 - 9 valent (6,11,16,18 + 31,33,35,45,52,58) - Given to 9-45 years all women

55
Q

Gardasil 9 effectiveness before and after exposure

A

Before exposure - 90% effective
After exposure - 40% effective

56
Q

Gardasil 9 schedule

A

0 day - 2 months - 6 months

57
Q

Treatment if pregnant women shows Malignant cell +v3 on pap smear

A

Conization for confirmation (done >12 wks) - abortion chances decreases

58
Q

Treatment of Stage 1A in Pregnant women

A

Go till term - C section - Radical hysterectomy + Lymphadenectomy

59
Q

Treatment in case of Stage 1B in Pregnant women

A

Fetal lung maturity >28 wks - C section - Radical Hysterectomy + Lymphadenectomy
4 week wait maximum

60
Q

Treatment of Stage 2 to 4 in Pregnant women

A

Radiotherapy
Beyond 28 wks - C section - Radiotherapy
1st trimester - Radiotherapy (Baby will abort himself)
2nd trimester - Try and see if gets viability

Obstetrics And Gynecology (2 decks)

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