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IPAP Senior OB Test 3 > Cervical Dysplasia & Cancer > Flashcards

Cervical Dysplasia & Cancer Flashcards

1
Q

This area of the cervix has glandular columnar cells

A

Endocervix

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2
Q

This area of the cervix has squamous cells

A

Ectocervix

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3
Q

where the glandular columnar cells meet the squamous cells on cervix is known as

A

Squamocolumnar Junction (SCJ)

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4
Q

when is squamous metaplasia most active

A

during adolescence / pregnancy

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5
Q

where do nearly all cervical neoplasia develop?

A

w/in transition zone of SCJ

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6
Q

what is a increased risk for cervical CA?

A

early age of 1st sexual intercourse / 1st pregnancy

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7
Q

Dietary deficiencies of what may alter immunity and promote viral persistence leading to cervical dysplasia

A

Vit A, C, E, beta carotene, folic acid

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8
Q

_____ –> decreased ______ –> allows genetic mutations over time –> _____

A

Old Age
Immunocompetence
Cancer

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9
Q

68y/o woman has a Hx of taking DES (Diethylstilbestrol) to prevent miscarriage in 1971 what does this put her at risk of

A

clear cell adenocarcinoma of vagina and cervix

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10
Q

Demographic risk factors for cervical neoplasia

A

Ethnicity (latin American, U.S. minorities)
Low socioeconomic status
increased age

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11
Q

Behavioral risk factors for cervical neoplasia

A 
Early coitarche
multiple sexual partners
male partner w/multiple prior sexual partners
tobacco smoking
dietary deficiencies
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12
Q

Medical risk factors for cervical neoplasia

A 
Cervical high-risk HPV Infx
Exogenous hormones (combine hormonal contraceptive)
parity
immunosuppression
inadequate screening
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13
Q

What is considered mild cervical dysplasia

A

Cervical Intrepithelial Neoplasia 1 (CIN 1)
abnormal cells confined to lower 1/3 of squamous epithelium
manifestation of HPV
(most regress after few years)

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14
Q

What is considered moderate cervical dysplasia

A

Cervical Intrepithelial Neoplasia 2 (CIN 2)
abnormal cells confined to middle 1/3 of squamous epithelium
mix of low and high grade
(~40% regress spontaneously w/in 2yrs)

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15
Q

What is considered Severe cervical dysplasia

A

Cervical Intrepithelial Neoplasia 3 (CIN 3)
abnormal cells confined to upper 1/3 of squamous epithelium
(risk of invasive cancer ~30% in 30yrs)

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16
Q

What is considered cervical carcinoma in situ

A

Full thickness involvement of cervix

17
Q

What CIN is considered precancerous

A

moderate-severe (CIN 2 and 3)

18
Q

what are the Low Risk HPV

A

6 / 11
visible genital warts, laryngeal papillomas, minority of subclinical HPV infx
(rarely oncogenic)

19
Q

what are the High Risk HPV

A

Types: 16 (MC), 18 (2nd MC), 31, 33, 35, 45(3rd MC)

persistent HPV infx required –> cervical cancer

20
Q

Pt w/ a HPV 16/18 leasion lasting >6months will develop what?

A

Squamous Intraepithelial Lesion (SIL)

21
Q

When do you screen for HPV?

A

women >/= 30
triage / surveillance of certain cytology abnormalities
post-Tx surveillance

22
Q

how often to complete pap screening in Pt <21

A

do not screen will likely clear infx

23
Q

how often to complete pap screening in Pt 21-29

A

pap q 3 yrs

24
Q

how often to complete pap screening in Pt 30-65

A

pap w/HPV (co-test) q 5yrs

pap alone q 3yrs

25
Q

how often to complete pap screening in Pt >65

A

no screening needed if no Hx of cervical changes- 3 neg paps in a row; 2 neg co-test in 10 yrs w/most recent in 5yrs

26
Q

Pap results return as ASC-US w/+HPV

A

Tx like LGSIL –> colposcopy

27
Q

Pap results return as ASC-US w/-HPV or w/o co-testing

A

repeat pap in 1 year

if still abnormal after 1yr –> colpo

28
Q

How to TX pregnant woman with pap results of ASC-US results

A

Tx as not pregnant
NO endocervical curette use or EMB
defer colpo until 6wks postpartum
biopsy only If high grade lesion

29
Q

How to TX pregnant woman with pap results of ASC-H results

A

Do NOT defer colpo until postpartum

30
Q

if you are unable to visualize entire transformation zone cant be seen w/colposcopy what should be done

A

LEEP (Loop electrosurgical excision procedure)

CKC (Cold Knife Cone)

31
Q

what is considered a poor prognostic indicator of cervical cancer that is not included in clinical staging

A

Lymphovascular spread

32
Q

Majority (70%) of all cervical cancers are what type and arise from where

A

Squamous Cell;

from ectocervix

33
Q

Adenocarcinomas of the cervix are usually ______ and have a _______ prognosis compared to Squamous cell

A

mucinous adenocarcinoma;

worse prognosis

34
Q

how to control abnormal bleeding w/cervical cancer

A

Monsel paste (ferric subsulfate) & vaginal packing

35
Q

How may those w/cervical cancer present

A 
watery/purulent/bloody discharge
polypoid mass/papillary tissue/ barrel shaped cervix
cervical ulceration/glandular mass
necrotic tissue
enlarged uterus
lymphadenopathy (spread)
Hydronephrosis (compressing ureters)
Constipation
36
Q

Tx of Cervical Cancer in pregnancy

A

early stages- may postpone TX until delivery

Advanced stages- Tx may lead to fetal losses

IPAP Senior OB Test 3 (6 decks)

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