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MOHD Keystone exam 3 > Cervical Cancer > Flashcards

Cervical Cancer Flashcards

1
Q

cancer of female reproductive system that is staged clinically

A

cervical cancer (C linically = C ervical); allows staging to occur in low resource setting

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2
Q

primarily spreads locally and via lymphatics

A

squamous cell carcinoma of the cervix

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3
Q

may spread hematogenously (3)

A
  • adenocarcinoma cervix
  • neuroendocrine tumors
  • small cell tumors cervix
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4
Q

treatment for cervical cancer is determined by:

A

clinical stage

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5
Q

cervical cancer incidence can be substantially decreased by:

A

improving adolescent HPV vaccination rates

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6
Q

Type of screening used for cervical cancer

A

cervical cytology screening

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7
Q

T or F:

High-risk HPV infection is necessary and sufficient for cervical cancer development

A

False:

High-risk HPV infection is necessary but INSUFFICIENT for cervical cancer

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8
Q

___ % HPV + women will resolve HPV on own within 24 months (if intact immune system)

A

90%

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9
Q

HPV __ & __ account for 90% genital warts

A

HPV 6 & HPV 11

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10
Q

most carcinogenic HPV

A

HPV 16; (55-60% all cervical cancers)

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11
Q

2nd most carcinogenic HPV

A

HPV 18 (10-15 % all cervical cancers)

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12
Q

HPV is a __ (shape), ___ (strands), ___ (nucleic acid) virus

A

circular, ds, DNA virus

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13
Q

RFs for oncogenic HPV:

A
  • immunocompromised (transplant, HIV)
  • smoking
  • early age at first intercourse
  • multiple partners
  • other STIs
  • low SES (poor nutrition)
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14
Q

Cervical cancer is a fast or slow process?

A

very SLOW process; may take 30 years to become invasive cancer

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15
Q

accounts for 80% of cervical cancers

A

squamous cell carcinoma

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16
Q

second most common type of cervical cancer

A

adenocarcinoma: HPV 16 and 18 are present in 90% of cervical adenocarcinomas

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17
Q

HPV 18 has highest association with what type of cervical cancer?

A

cervical adenocarcinoma

18
Q

ages of males and females for HPV vaccination (as recommended by CDC and ACIP)

A

female: 11-26 y.o.
male: 11-12 with “catch-up” to 26 y.o.
(nonavalent = all 11 and 12 year olds)

19
Q

types of HPV vaccines (3) and what they cover

A

quadrivalent: 6, 11, 16, 18
bivalent: 16, 18
nonavalent: 6, 11, 16, 18, 31, 33, 45, 51, 58

20
Q

efficacy of HPV vaccines (if naive to HPV genotype when vaccinated)

A

nearly 100%

21
Q

primary prevention for cervical cancer

A

HPV vaccine

22
Q

secondary prevention for cervical cancer

A

cervical cytologic screening

23
Q

initial screening for cervical cancer begins at age:

A

21

24
Q

cervical cytology screening recommendations:

A

initial at age 21; every 3 years ages 21-65

25
Q

reason for not screening for cervical cancer prior to age 21

A
  • 90% HPV infections are naturally resolved within 24 mos in healthy adolescents
  • adolescent cervix is immature and has higher incidence of HPV-related dysplasia
  • unnecessary treatment has economic, emotional and future childbearing implications (sig. increase in premie births)
26
Q

Exceptions for cervical cytology screening recommendations:

A
  • immunosuppressed
  • HIV
  • DES exposure in utero
  • prior cervical cancer or HG dysplasia treatment
27
Q

symptoms of cervical cancer include:

A
  • abnormal bleeding (b/w periods, w/ intercourse, after menopause
  • unusual vaginal discharge
  • leg pain, pelvic pain
  • anuria
  • NONE
28
Q

diagnosis of cervical cancer is made by:

A
  • screening test: cervical cytology
  • confirmed by biopsy
  • (biopsy is sufficient if visible tumor is present)
29
Q

20-30% risk of CIN 3+ over 5 years is predicted by:

A

HPV 16 persistence of 1-2 years

30
Q

30% probability of invasive cervical cancer over 30 years is predicted by:

A

untreated CIN 3 (VERY SLOW) (treated has 1% probability)

31
Q

T or F: Debulking is used for treating cervical cancers

A

False: spread is wide and is difficult to get negative margins with debulking

32
Q

Pattern of spread for cervical cancers:

  • local invasion or distant mets?
  • lymphatic or hematogenous?
  • retro or intraperitoneal?
A
  • local invasion
  • lymphatic spread (SCC) AND hematogenous spread (adenocarcinoma, NE tumor, small cell tumor)
  • intraperitoneal invasion (spread wide to pelvic wall) = poor prognosis
33
Q

cervical cancer limited to cervix is stage:

A

I

34
Q

cervical cancer in pelvic side wall and/or lower third of vagina is stage:

A

III (5 yr survival = 47-50%)

35
Q

cervical cancer in adjacent organs and beyond true pelvis is stage

A

IV(20-30% 5 yr)

36
Q

cervical cancer in uterus/parametria/vagina

A

stage II

37
Q

treatment of cervical cancer with distant mets (IV):

A

systemic chemotherapy

38
Q

radical hysterectomy with pelvic LN dissection is performed in stage ___ cervical cancer

A

early stage (1-1B)

39
Q

chemoradiation as main therapy is indicated in ___ stage cervical cancer

A

locally advanced (1B2-4A)

40
Q

Recurrence rate is ___ within 2 years

A

80% (really only get 1 shot at treating)

41
Q

Favorable prognostic factors for recurrence

A
  • localized, ventral pelvis
  • disease free interval > 6 mo
  • size
42
Q

-pelvic exenteration is indicated if:

and involves:

A
  • isolated central recurrence
  • removal of all pelvic reproductive organs, bladder, distal ureters, pelvic floor, rectum, anus
  • reconstruct via urostomy, colostomy and possibly vagina

MOHD Keystone exam 3 (9 decks)

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