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Clin Med Final Material- Semester 2 > Cervical Cancer Screening-Dobbs > Flashcards

Cervical Cancer Screening-Dobbs Flashcards

1
Q

Cervical Cancer:

-incidence/Prevalence

A
  • 12,000 new cases invasive cervical cancer diagnosed each year in US
  • 4,000 deaths per year in US
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2
Q

more than ___% of Pts with early cancer of the cervix can be cured

A

95%

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3
Q

Lifetime cumulative risk of acquiring HPV in sexually active persons = ____%

A

50-80%

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4
Q

How many different types of the HPV virus?

A

130

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5
Q

List the 15 HIGH risk HPV types?

A

**16, **18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73, 82)

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6
Q

Which HPV types are associated with cervical CA?

A

16, 18, 31, 33

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7
Q

which HPV types are associated with genital warts?

A

6,11

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8
Q

*>___% of invasive cervical carcinoma show the presence of HPV

A

> 90%

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9
Q

Risk Factors for Cervical Neoplasia: (list Ex’s)

A 
Early onset of intercourse
Multiple sexual partners
Sex partners who have had multiple partners
Cigarette Smoking (2-4x risk)
Immunosuppression
Sexually transmitted infections
DES exposure
Infrequent or absent pap screening tests
Long-term OCP use (five years of greater)
Multiple births (greater than 3)
Low socioeconomic status
Diet
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10
Q

Spectrum of HPV: (hint: CIN 1..)

A
  • Condyloma
  • Mild dysplasia (CIN 1)
  • Moderate dysplasia (CIN 2)
  • Severe dysplasia (CIN 3)
  • Cervical Cancer, carcinoma in situ (CIS)
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11
Q

The Pap Smear has led to >__% decrease in rates of cervical cancer in developed countries over last 30 yrs due to widespread screening

A

> 50%

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12
Q

T/F: Pap smear is a medical screening method

A

TRUE! it is not a diagnostic test!! just a screening method

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13
Q

Pap Smear:

  • detects premalignant and _____
  • Prevents ?
A

malignant cell changes of cervix

**Prevent progression of abnormal cells to cancer

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14
Q

Pap smear: uses sample cervical cells from _______ zone. The Junction of ______ and ________

A
  • *transformation zone

- - Junction of endocervix and ectocervix

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15
Q

Cervical Cancer Screening Guidelines: 2018 USPSTF

A

Age < 21 - No screening

Age 21-29 - Pap smear alone every 3 years

Age 30-65 - Pap smear with HPV co-testing every 5 years –or- Pap alone every 3 years

Age >65 - No screening is necessary after adequate negative prior screenings in past 10 years

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16
Q

Annual screening is required if..

A
  • **Pt is HIV infected - screen twice in the first year after diagnosis, then annually
  • Immunocompromised
  • Exposure to DES in utero
  • Women previously treated for cervical cancer
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17
Q

Stop screening for cervical CA at 65 yrs if …

A
  • 3 prior consecutive normal paps
  • No history of abnormal screening in last 10 yrs

-Stop screening if hysterectomy for benign disease with no history of abnormal Pap smears

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18
Q

How are pap smears classified?

A

Bethesda system

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19
Q

If pap smear is abnormal:

A
  • **further diagnostic testing needed
  • HPV DNA testing is standard
  • Biopsy of suspicious lesions is mandatory
  • Colposcopy with biopsies is most appropriate histologic technique
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20
Q

Bethesda Classification: Squamous cell

A
  • Atypical squamous cells (ASC)
  • Low Grade Squamous Intraepithelial Lesion (LSIL)
  • High Grade Squamous Intraepithelial lesion (HSIL)
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21
Q

List subtypes of Atypical Squamous cells (ASC)

A
  • Undetermined Significance (ASC-US)

- Not to exclude High Grade (ASC-H)

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22
Q

Bethesda Classification: Glandular Cell

A
  • Atypical Glandular cells (AG)
  • -Undetermined significance (AG-US)
  • -Favors neoplasm
  • Adenocarcinoma in Situ (AIS)
  • Adenocarcinoma
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23
Q

Koilocytes=

A

squamous epithelial cells affected by HPV

24
Q

Colposcopy:

-describe

A
  • Acetic acid and Lugol’s iodine, if needed

- Biopsies as needed

25
Q

Silver nitrate or Monsel’s for ______

A

hemostasis

26
Q

Women > 30 with negative cytology, HPV + :

A

2 options: Repeat cotesting @ 1 year OR HPV DNA typing

  • then colposcopy is any findings are positive
  • Manage by ASCCP guidelines
27
Q

Management of Women Ages 21-24 years with either Atypical Squamous Cells of Undetermined Significance OR Low-grade Squamous Intraepithelial Lesion (LSIL)

A

2 initial options: Repeat Cytology at 1 year OR Reflex HPV testing
-IF HPV positive and ASC-H or AGC or HSIL–> get colposcopy

28
Q

Management of women with atypical Squamous cells: cannot exclude High-grade SIL

A

-start with colposcopy—> if No CIN2,3–> manage per ASCCP guidelines

29
Q

Management of Women with Low-grade Squamous intraepithelial lesions (LSIL)

A

-IF LSIL with negative HPV test–> repeat cotesting at 1 year–> if negative–> repeat cotesting at 3 years

IF LSIL with no HPV test–> colposcopy

-IF LSIL with postive HPV test–> colposcopy

30
Q

Management of women with High-grade squamous intraepithelial lesions (HSIL):

A

Immediate loop electrosurgical excision OR colposcopy (w/ endocervical assessment)–> CIN2,3–> Manage per ASCCP guidelines

31
Q

When NOT to Discontinue Screening Following a Hysterectomy

A
  • Women with a history of CIN 2 or CIN 3 – or in whom a negative history cannot be documented should continue to be screened. Recurrent intraepithelial neoplasia or Ca at the vaginal cuff is possible years post op
  • Screening interval may be extended after 20 years
  • Cervix is still present
32
Q

CIN (Cervical intraepithelial neoplasia)=

A

disordered growth of epithelial lining of cervix

33
Q

CIN 1=

A

Mild dysplasia, disordered growth of lower third of epithelial lining

34
Q

CIN 2=

A

Moderate dysplasia, abnormal maturation of lower 2/3 of lining

35
Q

CIN 3=

A

Severe dysplasia, encompasses more than 2/3 of the epithelial thickness

36
Q

CIN MC occurs in women in their ____ (age?)

A

20’s

37
Q

CIS=

A

carcinoma in situ

38
Q

Describe CIS

A

Full thickness

In those aged 25-35yo

39
Q

Cervical cancer:

-MC demographic

A

age over 40 yo

40
Q

LEEP (loop electrosurgical excision procedure):

-is frequently used to treat:

A

CIN II or CIN III

41
Q

Describe LEEP

A
  • LEEP uses small, fine, wire loop attached to an electrosurgical generator to excise tissue of interest
  • Outpatient procedure
42
Q

Cone Biopsy:

-conization=

A
  • Excision of a cone shaped portion of cervix using a scalpel. The procedure is used when the neoplasia is larger, taking out larger cone of tissue, more likely to lead to incompetent cervix than LEEP
  • Requires hospitalization
43
Q

Cervical Cancer:

-S/Sx=

A 
Initially asymptomatic
Abnormal Vaginal Bleeding
Postcoital Bleeding
Vaginal discharge (watery, mucoid, purulent, malodorous)
Tumor may be seen on exam
44
Q

2 Types of Cervical Cancer:

A
  • Squamous Cell CA

- Adenocarcinoma (Glandular)

45
Q

Staging of Cervical CancerInternational Federation of Gynecology and Obstetrics (FIGO)
(0- IV)

A

0 - Carcinoma in situ – some of the cells of the cervix have cancer, but cancer is confined to surface of cervix

I - Cervix carcinoma confined to uterus

II - Carcinoma invades beyond uterus but not to pelvic wall or to the lower third of vagina.

III - Tumor extends to pelvic wall and/or causes hydronephrosis or nonfunctioning kidney

IV - Tumor extends beyond true pelvis or has involved bladder or rectum

46
Q

Treatment of Cervical Cancer

A
  • Invasive carcinoma of the cervix spreads primarily by direct extension and lymph nodes
  • Therapy must address primary tumor and also adjacent tissue and lymph nodes

-Radical hysterectomy plus pelvic lymphadenectomy, radiation with concomitant chemotherapy, or a combination of these

47
Q

Tx of cervical CA depends on:

A

age, childbearing, disease stage, comorbidities, patient & physician preference

48
Q

Cervical Cancer Follow Up

A
  • Approximately 35% of patients with invasive cervical cancer will have recurrent or persistent disease
  • Clinical evaluation every 3 months for high risk patients to year 5
  • Clinical evaluation every 6 months for low risk patients to year 5
  • Pap test yearly
  • Recurrence suspected, CT and or PET scan
49
Q

Significance of an Abnormal Pap in Adolescents

A

-High risk of cytological abnormalities–>North American participants in Gardasil trial (age 20 yrs) had 6.1% ASCUS; 6.2% LSIL 1

  • Most LSIL/CIN 1 regresses spontaneously
  • ->Study of 187 women with LSIL age 18-22 2

61% regressed to normal in 1 year

91% regressed to normal in 3 years

3% progressed to CIN 3
Very rare

50
Q

Consequences of Screening Adolescents for Cervical CA

A
  • Anxiety
  • Cost
  • Long term consequences of overuse of follow-up procedures (abnormal cytology leads to additional tests to identify CIN 2/3 -> This then leads to treatment)
51
Q
  • Treatment for lesions in adolescents destined to resolve without therapy
  • Treatment for CIN (LEEP) increases risk of: ?
A
  • Preterm birth
  • Low Birth weight
  • Preterm premature rupture of membranes (PPROM)
52
Q

Management of women Diagnosed with Adenocarcinoma in-situ (AIS)
-tx?

A

**hysterectomy preferred

-2nd line= conservative management

53
Q

HPV Vaccine:

-Is Gardasil available?

A
  • Gardasil 9 (Gardasil and Cervarix no longer available in the U.S.)
  • Active against HPV
    • FDA approved in US for girls & boys ages 9–26 years
    • CDC recommends all girls and boys 11-12 y/o receive series of vaccines

NOTE: Not for pregnant women

  • Can be given to women with previous abnormal cervical cytology
  • Doesn’t affect cytology schedules.
54
Q 
A 24yo female presents for routine gynecologic exam. History is significant for first birth at age 16yo and second birth at 18yo. Since separation from her husband at age 19yo, she has had several sexual partners. Pelvic exam reveals condylomata acuminata on the labia. For what gynecologic neoplasm is this women at the highest risk? 
A. Cervical Cancer
B. Endometrial Cancer
C. Ovarian Cancer
D. Breast Cancer
A

?

55
Q 
A 34 year old G2P2 female presents with vaginal discharge, dysuria, and dyspareunia.  What test is not indicated?
A. Chlamydia test
B. Gonorrhea test
C. Pap smear
D. Urine dip
E. Wet prep
A

Pap smear ?

Clin Med Final Material- Semester 2 (22 decks)

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