CERVICAL CANCER (SB) Flashcards
What are the primary risk factors for cervical cancer?
Early onset and frequent sexual contact, multiple sexual partners, history of STI, HPV infection, OCP use, smoking (SCCA), history of vulvar or vaginal dysplasia.
What is the most common sexually transmitted infection associated with cervical cancer?
Human papillomavirus (HPV).
What type of virus is HPV?
Double-stranded DNA virus that replicates within epithelial cells.
Which HPV types are considered high risk and responsible for more than 70% of cervical cancers?
HPV 16 and HPV 18.
What are the three types of HPV vaccines?
Bivalent (Cervarix), Quadrivalent (Gardasil), and Nonavalent (Gardasil 9).
At what ages is HPV vaccination recommended?
Boys and girls aged 11-12 years (as early as 9 years), with catch-up vaccination recommended for females aged 13-26 who have not been previously vaccinated.
What is the primary method of secondary prevention for cervical cancer?
Pap smear and HPV testing.
Between what ages should routine cervical cancer screening be performed?
Ages 21-65.
What is the recommended screening for women aged 21-29 years?
Pap testing every 3 years, no HPV testing.
What is the recommended screening for women aged 30-65 years?
Co-testing with Pap and HPV testing every 5 years (preferred) or Pap testing alone every 3 years.
Under what conditions can cervical cancer screening be discontinued in women over 65?
Three consecutive negative Pap smears or two consecutive negative HPV tests with no history of CIN 2+ in the past 20 years.
What is the transformation zone in the cervix, and why is it significant?
The transformation zone is the area where the squamous epithelium of the ectocervix meets the columnar epithelium of the endocervix; it is the site where cervical cancer commonly develops.
What is cervical intraepithelial neoplasia (CIN)?
A histologic diagnosis of precancerous lesions in the squamous epithelium of the cervix, graded as CIN 1, 2, or 3.
Which CIN grade is most likely to regress spontaneously?
CIN 1.
Which CIN grade is a precursor to invasive cancer?
CIN 3.
What is the histologic characteristic of CIN 3?
Cellular atypia involves more than two-thirds of the epithelial layer with an increased nucleus-to-cytoplasm ratio and rapid cell division.
What is the significance of atypical squamous cells of undetermined significance (ASC-US) on a Pap smear?
Atypical cells are present, but their significance is unclear. Follow-up includes repeat cytology at 12 months or HPV testing.
What should be done if a patient has ASC-US and a positive HPV test?
Perform colposcopy.
What is the preferred management for a patient with ASC-H (atypical squamous cells - cannot exclude high-grade lesion)?
Colposcopy to evaluate for CIN 2/3.
What is the histologic correlation of low-grade squamous intraepithelial lesion (LSIL)?
LSIL is consistent with CIN 1.
What is the management for a patient with LSIL and a negative HPV test?
Repeat HPV and Pap testing in 1 year.
What is the next step for a patient with LSIL and a positive HPV test?
Perform colposcopy.
What is the recommended management for CIN that persists for more than 2 years?
Excision procedure.
What percentage of unmanaged CIN 2/3 cases progress to cervical cancer?
0.2
What is the next step in the management of high-grade squamous intraepithelial lesion (HSIL)?
Colposcopy.
What are the treatment options for HSIL depending on age and biopsy results?
Excision or ablation.
What percentage of Pap tests show atypical glandular cells (AGC)?
Approximately 3 out of every 1000 Pap tests.
What is the risk of underlying invasive cancer in patients with atypical glandular cells?
3% to 17%.
What is the recommended evaluation for atypical glandular cells (AGC)?
Colposcopy with endocervical sampling.
What additional test should be performed for patients over 35 years old with AGC?
Endometrial sampling.
What risk factors indicate the need for endometrial sampling in AGC?
Unexplained vaginal bleeding, obesity, chronic anovulation (e.g., PCOS), or family history of Lynch syndrome.
What is the first step in evaluating women with abnormal cytology?
Colposcopy.
What is a colposcope?
A low-power binocular microscope with a light source used to examine the cervix.
What solution is applied to the cervix during colposcopy to highlight abnormal areas?
Diluted 3-5% acetic acid.
What does an acetowhite lesion on colposcopy indicate?
Possible dysplastic or cancerous cells.
Why do dysplastic cells appear white after applying acetic acid?
Acetic acid dehydrates epithelial cells; dysplastic cells with large nuclei reflect light and appear white.
When is a colposcopy considered ‘satisfactory’?
When the entire transformation zone is visible and assessed.
What is recommended if a colposcopy is ‘unsatisfactory’?
Endocervical curettage (ECC).
What are common hemostatic agents used after a cervical biopsy?
Ferric subsulfate (Monsel’s solution) or silver nitrate sticks.
What are the two main types of treatment for cervical dysplasia?
Ablative and excisional procedures.
What are the common ablative treatments for cervical dysplasia?
Cryotherapy and CO2 laser ablation.
What is the most common method of excisional treatment for cervical dysplasia?
Loop Electrosurgical Excision Procedure (LEEP).
What is the purpose of cold knife conization?
To excise the cervix for histopathologic examination and ensure clear margins.
What is the most common histologic type of cervical cancer?
Squamous cell carcinoma (SCCA).
What are the subtypes of squamous cell carcinoma of the cervix?
Large cell (keratinized or non-keratinizing), small cell, and verrucous carcinoma.
What is the significance of verrucous carcinoma of the cervix?
Rare, resembles vulvar warty tumors, rarely metastasizes unless mixed with typical SCCA.
What are the subtypes of adenocarcinoma of the cervix?
Endocervical, endometrioid, clear cell, adenoid cystic, and adenoma malignum.
What is the worst prognostic subtype of adenocarcinoma?
Clear cell adenocarcinoma.
Which cervical adenocarcinoma subtype is associated with diethylstilbestrol (DES) exposure?
Clear cell adenocarcinoma.
What is the significance of adenoid cystic carcinoma of the cervix?
Aggressive, resembles basal cell carcinoma, more common in women over 60.
What is adenoma malignum (minimal deviation adenocarcinoma)?
A rare, highly invasive mucinous adenocarcinoma with early metastasis.
What is the mixed histologic type of cervical cancer?
Adenosquamous carcinoma.
What is a particularly aggressive form of adenosquamous carcinoma?
Glassy cell carcinoma.
Why is glassy cell carcinoma considered highly aggressive?
It metastasizes early to lymph nodes and distant sites, often leading to poor outcomes.
What are the common clinical presentations of cervical cancer?
Abnormal bleeding, abnormal discharge, intermenstrual bleeding, postcoital bleeding, foul-smelling vaginal discharge.
What are the three biopsy tools used for diagnosing cervical cancer?
Kevorkian, Eppendorf, Tischler.
What imaging and diagnostic tests are used in clinical staging of cervical cancer?
Physical exam, chest X-ray (CXR), intravenous pyelography (IVP), CT scan.
What is FIGO Stage 1 cervical cancer?
Cancer is confined to the cervix.
What is FIGO Stage 2 cervical cancer?
Cancer has spread to the uterus, kidneys, or lower third of the vagina.
What is FIGO Stage 3 cervical cancer?
Cancer has spread to lymph nodes.
What is FIGO Stage 4 cervical cancer?
Cancer has metastasized to distant organs.
What is the most common lymph node metastasis site for cervical cancer?
Parametrial lymph nodes.
What are the three macroscopic appearances of cervical cancer?
Ulcerated, exophytic (cauliflower-like), endophytic.
What is an endophytic cervical tumor?
A deeply invasive tumor that originates from the endocervix, filling the cervix and lower uterine segment (barrel-shaped cervix).
What are the most important prognostic factors for cervical cancer?
Tumor size, lymph node involvement, and FIGO stage.
What is the significance of tumor diameter in FIGO staging of stage I cervical cancer?
Stage IB1 is ≤4 cm, Stage IB2 is >4 cm.
What is the primary management for Stage I-IIA cervical cancer?
Radical hysterectomy with bilateral lymphadenectomy or radiation therapy.
What is the main treatment for Stage IIB, III, and IVA cervical cancer?
Chemoradiation.
When is neoadjuvant chemotherapy used in cervical cancer?
Before surgery or radiation therapy.
When is extended field radiation used in cervical cancer treatment?
When there is paraaortic lymph node involvement.
What is the recommended follow-up schedule for cervical cancer survivors in the first 5 years?
Every 3 months for the first 2 years, every 6 months from years 3-5, then yearly after 5 years.
What tests are included in follow-up monitoring for cervical cancer?
Physical exam, Pap smear, CXR, PET scan, renal function test.
When do most cervical cancer recurrences occur?
Within 2 years.
What is the main treatment for pelvic recurrence of cervical cancer?
Chemoradiation.
What is pelvic exenteration?
An extensive surgical procedure for central pelvic tumor recurrence when curative treatment is possible.
What is anterior pelvic exenteration?
Removal of the bladder, uterus, cervix, and all or part of the vagina.
What is posterior pelvic exenteration?
Removal of the anus, rectum, uterus, cervix, and all or part of the vagina.
What is total pelvic exenteration?
Removal of all pelvic contents.
When is pelvic exenteration NOT performed?
For palliative purposes.
What percentage of cervical cancer recurrences occur in the pelvis?
Approximately 50%.
What imaging modality is useful in assessing pelvic recurrence?
Vaginal ultrasound scan.
What are the treatment options for non-pelvic recurrence of cervical cancer?
Radiation, surgery, chemotherapy.
When can localized non-pelvic recurrences be treated with radiation?
When they occur in areas not previously irradiated.
When is metastasis resection considered in cervical cancer recurrence?
When a solitary metastasis occurs 3-4 years after primary therapy.
