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OB/Gyn > Cervical Disorders > Flashcards

Cervical Disorders Flashcards

1
Q

What are the Non-Sexual Risk Factors for Cervical Cancer?

A
  1. Multiparity, 2-4x risk.
  2. Use of Tobacco, 2-4x risk.
  3. Inadequate or NO screening, 2-6x risk**
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2
Q

What is the 3rd most common malignancy in women worldwide?

A

Cervical Cancer.

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3
Q

What are the Sexual Risk Factors (4) for Cervical Cancer?

A
  1. Early age @ first intercourse, 2-4x risk.
  2. Multiple Sexual partners, 2-5x risk.
  3. PREVIOUS Hx of STI’s, 2-10x risk.
  4. INFECTION w/HPV, >20x risk**
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4
Q

What is the main risk factor for cervical cancer?

A

Oncogenic HPV infection.

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5
Q

Which specific HPV increases the rate of severe dysplasia (CIN3) and cervical cancer?

A

Positive infection of HPV 16 or 18.

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6
Q

What age is cervical cancer most frequently diagnosed? Average age?

A

Between the ages of 35-44 w/the average age at 50.

*Rarely diagnosed younger than 20.

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7
Q

What race/ethnicity is most prevalent for cervical cancer?

A

Hispanic > AA > White > American Indian > Asian/Pacific Islander.

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8
Q

What are some benign lesions of the cervix?

A

Ectropion, Cervical Polyps, Nabothian Cyst.

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9
Q

Columnar epithelium replacing squamous epithelium on the outer surface of the cervix that develop in response to hormonal changes, chronic inflammation and is a normal among women of child-bearing age?

A

Ectropion.

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10
Q

The proliferation of benign stroma covered by epithelium and most commonly visible on the cervical os on speculum examination?

A

Cervical polyp.

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11
Q

Can be pedunculated or sessile and may be due to an inflammatory proliferation?

A

Cervical Polyp.

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12
Q

What are the principal symptoms of a cervical polyp?

A

Discharge and abnormal bleeding, which should be further evaluated and not completely attributed to a cervical polyp.

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13
Q

Dilated, obstructed mucosa glands that are covered by squamous epithelim?

A

Nabothian cyst.

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14
Q

Do nabothian cysts need to be treated?

A

No treatment; they are benign lesions.

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15
Q

What is the difference between Cytology and Histology?

A

Histology is evaluation of tissues done with a biopsy of tissues; where a Cytology is the study of a collection of cells.

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16
Q

What is the transformation zone?

A

An area of metaplasia or the transformation of one differentiated cell type to another differentiated cell type. The change may be benign or malignant.

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17
Q

What part of the female anatomy is the most common area for cell differentiation?

A

The cervix is an area of active squamous cell proliferation.

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18
Q

What does LSIL and HSIL stand for?

A

LSIL – Low-grade Squamous intraepithelial lesion.

HSIL – High-grade Squamous intraepithelial lesion.

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19
Q

What does CIN stand for?

A

Cervical Intraepithelial Neoplasia.

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20
Q

CIN2 that is p16 positive is classified as?

A

HSIL.

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21
Q

CIN2 that is p16 negative is classified as?

A

LSIL.

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22
Q

What is the Bethesda Classification System?

A

It is a standardized system to classify cervical and vaginal cytology (pap) and histology.

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23
Q

What is the previous term for classification of LSIL and CIN1?

A

Mild Dysplasia.

*CIN1 is low-grade and pre-cancerous.

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24
Q

What is the previous term for classification of HSIL and CIN2?

A

Moderate Dysplasia.

*CIN2 is high-grade and pre-cancerous.

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25
Q

What is the previous term for classification of HSIL and CIN3?

A

Either Severe Dysplasia or Carcinoma in-situ.

*CIN3 is high-grade and a cancerous lesion.

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26
Q

Non-enveloped double-stranded DNA virus?

A

HPV – Human Papillomavirus.

**>100 different types.

27
Q

What are HPV 6 and 11 most often associated with?

A

90% External Genital Warts – Condyloma Acuminata.

28
Q

Of the 15-20 oncogenic types of HPV, which account for the majority of worldwide cervical cancers?

A

HPV 16 (54%) and HPV 18 (13%).

29
Q

What will most males and females be infected with and never know?

A

HPV infection – at least one type of mucosal HPV at some point in their lives.

30
Q

What age group is HPV infections most common in?

A

Teens and early 20s.

31
Q

What are the mechanisms of HPV transmission and Acquisition?

A
  1. Sexual contact (MC means of transmission):
    - -intercourse, genital or oral contact; may result from a non-penetrative sexual contact.
  2. Non-sexual routes:
    - -mother to newborn.
    - -Fomites (undergarments, surgical gloves, etc; hypothesized but not well documented).
32
Q

What is the approximate time of HPV infection from time of first sexual intercourse?

A

Approx. 40% of HPV infections occurred within 2 yrs of first sexual intercourse.

33
Q

What percentage of HPV infections are transient in women b/t ages of 15-25 and what is the median length of infection?

A

80%, medial length of 8 months for infection to clear with as long as 24 months.

34
Q

Which HPV type is seen more often as a persistent infection?

A

HPV 16.

35
Q

What age groups have the highest prevalence of HPV infection?

A

Ages 20-24 yrs.

36
Q

What is the importance of HPV infection?

A

HPV persistence is KEY!!!

–If the infection is persistent with high-risk oncogenic HPV subtypes, the risk is higher for development of pre-invasive and invasive disease.

37
Q

What is another important aspect of the HPV infection?

A
  1. Most HPV infections are asymptomatic.

2. 90% of cases are cleared by the body’s immune system in 2 yrs.

38
Q

What area of the female anatomy is the most vulnerable to HPV-related disease?

A

The transformation zone.

39
Q

Who are considered the Rarely and Never Screened for cervical cancers?

A

Minorities, Low SES, Foreign born (living in the US <10 yrs), No usual source of health care.

40
Q

When does cervical cancer screening begin?

A

At age 21.

*Women <21 should NOT be screened regardless of age of sexual contact.

41
Q

These tests lead to an increase in detection of high-grade precancerous lesions?

A

PAP and HPV testing for women of age 30-65 yrs completed every 5 yrs.

42
Q

What age do we stop screening for cervical cancer?

A

Age 65 for women with adequate negative prior screening within the last 20 yrs.

43
Q

What is the rationale for stopping cervical cancer screening at age 65?

A

CIN2+ is rare after age 65 and the incident HPV infection is unlikely to lead to cancer within the remaining lifetime.

44
Q

Is screening for vaginal cancer necessary after a hysterectomy?

A

No. Primary vaginal cancer is rare.

45
Q

Should screening for cervical cancer be continued after treatment of a high-grade precancerous lesion?

A

Yes, continued for 20 yrs after treatment with a cytology alone every 3 yrs.

46
Q

What does ASCUS stand for?

A

ASCUS – Atypical Squamous cells of undetermined significance.

**It is the MC abnormal pap finding.

47
Q

What is the mgmt of a 21-24 y/o w/LSIL, ASCUS or ASCUS positive HR HPV?

A

**Repeat PAP in 1 yr.

*Observation for 2 yrs w/low-grade cytological abnormalities.

48
Q

What is the mgmt of a 21-24 y/o w/ASC-H, HSIL, AGC?

A

Colposcopy.

**ASC-H: Atypical/Abnormal Squamous Cells, cannot r/o HSIL.

**AGC: Atypical glandular cells.

49
Q

What is the mgmt of a 25 and older with ASCUS positive HR HPV or greater (ASC-H, HSIL, AGC)?

A

Colposcopy.

50
Q

What is the mgmt of a 30 yr and older with LSIL negative for HR HPV?

A

Repeat co-test (PAP test w/HR HPV) testing in 1 yr.

51
Q

What is the mgmt of a 30 and older with LSIL HPV unknown or HR HPV positive?

A

Colposcopy.

52
Q

What is a Colposcopy?

A

A type of procedure that closely examines the cervix, vagina and vulva for disease; the instrument used is a colposcope.

53
Q

What is the mgmt of a woman age >30 y/o with a HPV negative ASCUS?

A

Re-screening w/cotesing in 3 yrs.

54
Q

What is the mgmt of a woman age >30 y/o with a HPV positive and negative cytology?

A
  1. Option 1 – 12 mo f/u w/co-testing.
  2. Option 2 – test for HPV 16 or HPV16/18 genotyping.
    - -If either positive, refer for a colposcopy.
    - -If either negative, 12 mo f/u w/co-testing.
55
Q

A well-demarcated, dense, opaque, acetowhite area in the transformation zone of the cervix?

A

CIN diagnosis via colposcopic.

56
Q

Neoplastic epithelial cells that have invaded the stroma underlying the epithelium?

A

Invasive cervical cancer; CIN3.

57
Q

Painful and embarrassing to treat and many pt’s experience recurrence after treatment?

A

Anogenital or External genital warts.

58
Q

All prophylactic HPV vaccines are made from?

A

Virus-like particles; it does not contain any virus DNA, therefore, it is non-infectious and cannot cause actual disease or cancer.

59
Q

Which HPV vaccine is most commonly used in the US?

A

9-Valent/9vHPV (Gardasil 9).

60
Q

What is the efficacy of the 9-valent HPV vaccine?

A

Approx. 97% protection against HPV 31, 33, 45, 52, 58 with similar protection against HPV 6, 11, 16, 18-related disease.

61
Q

Dosage guidelines for the HPV vaccine?

A
  1. Series started before age 15: 2 doses (0, 6-12 mo).

2. Series started on or after age 15: 3 doses (0, 1-2, 6 mo).

62
Q

What age do we give the HPV vaccine?

A
  1. Routine vax at age 11 or 12 yrs; can start as early as 9.
  2. Up to age 26 for females.
  3. Up to age 21 for males w/exception of MSM or immunocompromised (HIV +).
63
Q

What is the cascade of events from non-cancer to invasive cancer?

A
  1. Infection w/HR HPV type (16/18).
  2. Establishment of a persistent HPV infection.
  3. Transformation of epithelial cells to pre-invasive neoplastic cells.
  4. Malignant transformation of intraepithelial neoplasia into invasive cancer.

OB/Gyn (14 decks)

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