Cervical Disease

Question 1

In the Cervix, the Transformation Zone is most vulnerable region to cancer. What types of epithelium meet here?

Answer 1

Glandular cells of the Endocervix
&
Squamous cells of Exocervix (b/c of acidic environment of vagina)

Question 2

Most common sexually transmitted infection in the US?

Answer 2

HPV

Question 3

HPV genome?

Answer 3

Double stranded circular DNA virus

Question 4

Which 2 HPV strands are responsible for 70% of cervical cancers?

Answer 4

16 & 18

Question 5

Which 4 HPV strands are responsible for 80% of cervical cancers?

Answer 5

16, 18, 31, 45

Question 6

HPV-___ found in 54% of squamous cell cancers

Answer 6

HPV-16

Question 7

HPV-___ found in 60% of adenocarcinomas

Answer 7

HPV-18

Question 8

90% of genital warts are associated with HPV types __ & __.

Answer 8

6 & 11

Question 9

HPV-__ in >50% of cervix cancer patients

Answer 9

HPV-16

Question 10

T or F?

Not all patients with HPV 16 or 18 progress to cervical cancer.

Answer 10

True

Question 11

HPV most common types worldwide?

Answer 11

HPV 16, 18 (preventable by vaccination)

Question 12

HPV: in women, most common between ages of __a__; incidence decreases after age __b__

Answer 12

a) 20-24

b) 30

Question 13

HPV risk factors for persistence?

Answer 13

• High risk strains
• Immunosuppression (HIV, SLE, medications, other)
• Cigarette smokers

Question 14

HPV genome:

1. Late (L) Proteins - function?
2. Long control region - function?
3. Early (E) proteins (viral oncogenes) - function?

Answer 14

1. Encode viral capsid proteins
2. DNA regulatory sequences
3. Ass’d with viral gene regulation, cell transformation and immortalization

Question 15

HPV genome - what are the functions of the E6 & E7 proteins?

Answer 15

E6 = interferes w/ normal function of p53

E7 = interferes w/ normal function of Rb protein

Question 16

p53 normally functions to do what 2 things?

Answer 16

1. Inhibits cell growth by inhibiting cell cycle transit from G1 to S phase
2. Tumor suppressor protein – pauses cell growth after chromosomal damage to allow DNA repair to occur

(First Aid: Transcription factor for p21; ass’d w/ Li-Fraumeni Syndrome)

Question 17

Rb normally functions to do what 2 things?

Answer 17

1. Inhibit cellular growth
2. Halts cell growth/induces apoptosis in response to DNA damage

(First Aid: Inhibits E2F & blocks G1→ S phase; ass’d w/ Retinoblastoma & Osteosarcoma)

Question 18

When E7 binds Rb → cells with damaged DNA can bypass ______, resulting in accumulation of abnormal cells and genomic instability

Answer 18

G1 growth arrest

Question 19

Diagnostic test of HPV?

Answer 19

Colposcopy

Pap smear is triage screening test

Question 20

Abnormal Pap smears are usually what?

Answer 20

Atypical squamous cells

Question 21

CIN - Tx?

When are these Txs used?

Answer 21

• Cryotherapy
• Loop Electrode Excision Procedure
• Conization
• Laser ablation

Used in High-grade CIN

Question 22

CIN treatment - Adverse side effects?

Answer 22

• Increase risk of preterm labor
• Cervical stenosis
• Bleeding, infection

Question 23

CIN treatment - efficacy?

Answer 23

Efficacy is good, but there is about a 10-20% recurrence rate

Question 24

Cervical cancer high risk:

• Ethnicity(ies)?
• Age range(s)?

Answer 24

• Hispanics, followed by African-American (AAs have highest mortality)
• 35-50 yrs.

Question 25

T or F? | Invasive cervical cancer is an AIDS defining illness.

Answer 25

True

Question 26

Gardasil - what is it?

Answer 26

Quadrivalent HPV recombinant vaccine - Prepared from virus-like particles (VLPs) to produce an antibody response against capsid proteins - HPV types 6, 11, 16 & 18 - Mediated by development of humoral immune responses

Question 27

ACOG HPV Vaccine Recommendations?

Answer 27

- Females and Males aged 9-26 years - Cervical cytology screening remains unchanged - Sexually active women including those with abnormal cytology & genital warts - Vaccination is not treatment