Cervical Intraepi Neoplasia and CA

Question 1

What are the Screening modalities for Cervical Cancer?

Answer 1

Cervical cytology
-Conventional pap smear
-liquid based testing
HPV screening(not recommended by itself)
Combination of Both

Question 2

What are the Screening recommendations for Cervical CA in Women aged 21-29 years old?

Answer 2

Begin at 21yo
Test with cytology
every 3yrs
Co-testing not recommended

Question 3

What are the Screening recommendations for Cervical CA in Women aged 30-65 years old?

Answer 3

Co-testing with cytology and HPV every 5 years
Screening with cytology alone every 3 years is acceptable
(not meant for women with major risk factors)

Question 4

What are the Screening recommendations for Cervical CA in special populations?

Answer 4

Invected with HIV- (2x first year, then annually) at age of Dx even if

Question 5

At what point can you stop screenign for cervical Cancer?

Answer 5

After Age 65 in women with no history of pos screening

Total Hysterectomy

Question 6

What is a colposcopy?

Answer 6

Illuminated, magnified view of the cervix, vagina and vulva

Acetic acid is used to improve visualization

Question 7

What is the effect of Acetic acid wash on cervix?

Answer 7

Dehydrates cells so squamous cells with dense nuclei will appear white

Question 8

What are the treatments for Cervical neoplasias?

Answer 8

Ablative: cryotherapy
Excisional: loop electrocautery excision procedure

Question 9

What is the most common type of Cervical cancer?

Answer 9

Squamous cell CA

Question 10

What are the traits of AdenoCA of the Cervix?

Answer 10

Endophylic
More aggressive
Microinvasion doesn’t apply
Skip lesion

Question 11

What is unique about cervical Cancer staging?

Answer 11

It is staged clinically(only gyn cancer that is staged clinically)

Question 12

What is involved in pre-treatment evaluation for Cervical CA?

Answer 12

PE
Bloodwork
CXR
Intravenous pyelogram
Cystoscopy
Sigmoidoscopy

Question 13

What are the treatment modalities for Cervical CA?

Answer 13

Stage IA1: Large, cold knife cone biopsy or simple biopsy
Stage IA2: and Stage IIA: Radical Hysterectomy
Stage IIB, III, IV: Rad therapy and chemo

Question 14

What is involved in a radiacal hysterectomy?

Answer 14

Resection of uterus and cervix
Pelvic side wall
Upper2/3 of vagina
Pelvic Node dissection
Sampling of para-aortic nodes

Question 15

What are the risks of Radical Hysterectomy?

Answer 15

Uereteral Occlusion
Ureteral Fistula
Bladder atony
Infection
Bleeding
Peripheral Lymphedema

Question 16

What are the 2 phases of Radiations therapy in Cervical CA Tx?

Answer 16

EBRT (external beam radaiation therapy)

Brachytherapy (intracavitary radiation of low dose)

Question 17

WHat are the complications of Radiation therapy on cevix?

Answer 17

GI ileus from scarring or acute rxn to rad therapy
GU- Urinary Freq
Vaginal Discharge
Dysparunia

Question 18

What is Pelvic Exenteration?

Answer 18

Radical procedure taking out all the pelvic organs
Uterus, tubes, ovaries, vagina
Bladder, distal ureters
Rectum and anus and pelvic floor
Levator muscles and pelvic LN

Colostomy and Ileal conduit created to bypass