Cervical Intraepithelial neoplasia

Question 1

Where does cervical cancer fall in terms of the incidence of gyn malignancies?

Answer 1

3rd

Question 2

In whom is incidence and mortality of cervical cancer the highest?

Answer 2

Incidence highest in hispanic women, but mortality highest in blacks

Question 3

When was it discovered that HPV causes cervical cancer?

Answer 3

2008

Question 4

Is HPV screening by itself recommended?

Answer 4

Not currently–combined with Pap

Question 5

What is an ectropion? Is this normal?

Answer 5

Cervix is inverted– this is normal

Question 6

What is the role of acetic acid in determining cervical abnormalities?

Answer 6

visualize abnormal areas by dehydrating so that squamous cells with dense nuclei will appear white

Question 7

What are nabothian cysts? Treatment?

Answer 7

Cervical mucus gland that is plugged

Self limiting and asymptomatic

Question 8

What is the recommendation for pap smears? (when start, how often, what is done)

Answer 8

• Begin at age 21 (regardless of age at first intercourse)
• Tested with cervical cytology alone (not HPV)
• q 3 years

Question 9

Why is co testing for HPV not recommended for pap smears for 21-29 years?

Answer 9

high prevalence in 21-29 years and low incidence of cervical CA

Question 10

When does HPV co-testing begin? How often? At what age does it stop?

Answer 10

• Co-test at 30-65 q 5 years

- Screen cytology alone 1 3 years

Question 11

Who should be screened for cervical cancer more often?

Answer 11

-immunocompromised
-h/o cervical CA
-

Question 12

When do Pap smears stop? Who is the exception to this?

Answer 12

65, unless immunocompromised or has a h/o cervical CA

Question 13

Do women with a total hysterectomy need a pap smear?

Answer 13

Nah

Question 14

Are pap smears and HPV testing recommended for below 21 years?

Answer 14

No

Question 15

True or false: most epithelial abnormalities require further assessment

Answer 15

True

Question 16

What is a colposcopy?

Answer 16

Microscope on wheels for cervical screens

Question 17

What are the treatment modalities for cervical cancer?

Answer 17

Cryotherapy

-Excisional (LEEP)

Question 18

What is the LEEP procedure?

Answer 18

Loop electrocautery excision

Question 19

When is a cone excision indicated?

Answer 19

Concern for deeper carcinoma

Question 20

What percent of cervical cancer is SCC?

Answer 20

90%

Question 21

Adenocarcinomas of the cervix are most commonly (endophytic or exophytic)? What are the characteristics of this in terms of malignancy?

Answer 21

Endophytic

Aggressive

Question 22

What are the lesions that are commonly found with adenocarcinoma of the cervix?

Answer 22

Skip lesions–start from multiple areas

Question 23

Does microinvasion apply to adenoCA?

Answer 23

No

Question 24

What are the s/sx of cervical CA? (if any)

Answer 24

• Vaginal d/c
• Odor
• Abnormal bleeding
• Postcoital bleeding

Question 25

What are the structures that are affected with direct extension of cervical CA?

Answer 25

- Involvement of the pelvic side wall - venous compression - Hydroureter

Question 26

What is the only gyn CA that is staged clinically?

Answer 26

Cervical

Question 27

What are IVPs? What are they used for?

Answer 27

Intravenous pyelogram-- an x-ray examination of the kidneys, ureters and urinary bladder that uses iodinated contrast material injected into veins

Question 28

What is stage 0 cervical CA?

Answer 28

CIS

Question 29

What is stage 1 cervical CA?

Answer 29

carcinoma confined to the cervix

Question 30

What is stage 2 cervical CA?

Answer 30

Carcinoma extends beyond the cervix either to the vagina or parametrium

Question 31

What is stage 3 cervical CA?

Answer 31

Lower 1/3 of the vagina or the pelvic side wall

Question 32

What is stage 4 cervical CA?

Answer 32

CA extends beyond the true pelvis or involves the mucosa of the bladder

Question 33

Treatment for cervical CA depends largely on what?

Answer 33

Staging

Question 34

What is the treatment for IA, IA2, IIB and above?

Answer 34

- IA1 = Excise - IA2 = Radial hysterectomy - II and above = XRT and chemo

Question 35

What is excised with a radical hysterectomy? (4)

Answer 35

- uterus + ovaries - pelvic side wall - upper 2/3 of vagina - pelvic nodes

Question 36

What are the risks of radical hysterectomy? (3)

Answer 36

- Ureteral occlusions - Ureteral fistula - Bladder atony

Question 37

Why bladder atony with radical hysterectomy?

Answer 37

Damage to the nerves

Question 38

What are the two different XRTs for cervical CA?

Answer 38

EBRT | Brachytherapy

Question 39

What is brachytherapy?

Answer 39

Intracavitary radiation --Place radioactive things in cervix to crush CA

Question 40

What are the complications of XRT to the cervix?

Answer 40

- Ileus - Urinary frequency - dyspareunia

Question 41

What is pelvic exenteration?

Answer 41

Radical procedure for recurrent cervical CA --Radial hysterectomy + cystectomy, and rectum removal

Question 42

True or false: HPV vaccines must be given before or at the onset of sexual activity to be effective

Answer 42

True

Question 43

What is the difference between partial, total, and radical hysterectomy?

Answer 43

``` Partial = just the uterus Total = uterus + cervix Radical = above + vagina ```

Question 44

What is the concern with performing the LEEP procedure?

Answer 44

If take too much tissue, may cause cervical issues