Cervical neoplasia Flashcards
Most cases of cervical cancer are in?
1 cancer killer of women in developing world
CIN I II III?
I is 1/3, II is 2/3, III is more than 2/3 INCLUDING full epithelial thickness
Screening guidelines for 21-29 year olds?
Pap every 3 years
Screening guidelines for 30 and older?
Pap test and HPV test.
If NEGATIVE, re-screen no sooner than every 5 years
If HPV testing isn’t available, screen with pap every 3 years.
When can cervical cancer screening stop?
Over age 65
Hysterectomy for benign reasons and no history of CIN 2 or higher.
HPV’s effect on a cell?
Nuclear enlargement, perinuclear cytoplasmic clearing, multinucleation, hyperchromasia (resolve when infection resolves)
Atypical squamous cells. Which categories go directly to colpo?
LSIL, HSIL, ASC-H (atypical squamous cell cannot exclude high-grade squamous intraepithelial lesion)
No HPV typing because almost everyone with these is positive.
What do you do with ASC-US?
HPV DNA testing aka. reflex HPV testing
ASC-US high-risk HPV negative?
Continue routine pap screening
ASC-US high-risk HPV positive?
Colpo and cervical biopsies if indicated
Patient >30 years old, normal pap but POSITIVE high-risk HPV?
Repeat pap and HPV screen in 12 months.
If abnormal, colpo.
If HPV TYPING is available, do that. If negative for the HIGH RISK STRAINS don’t need colpo.
Changes on colposcopy that warrant biopsy?
Acetowhite epithelium, mosaicism, punctations, atypical vessels
Options for CIN I lesions?
Repeat pap (cytology) 6 months x 2
OR
Repeat HPV testing in 1 year
If either pap is abnormal OR if the high-risk HPV is positive, REPEAT COLPO AND BIOPSY.
LEEP if persistent for 2 years
Options for CIN II and III lesions?
Surgical excision via LEEP (formerly was cold-knife conization)
Infrequent complications of LEEP or CKC?
Cervical stenosis, cervical insufficiency, infection, bleeding
What kind of follow up for after LEEP? When can patient return to routine screening?
Repeat pap every 6 months
or
Repeat pap and colpo for 1 year
If normal results for at least 20 years.
How does SCC cervical cancer metastasize?
Direct extension
SCC vs. Adenocarcinoma prevalence?
80% SCC
How is cervical cancer staged?
CLINICALLY
Staging
A’s are down, B’s are across
Stage Ia vs Ib?
Ia- cervix only 5 x 7 wide
Ib- Cervix only but bigger than 5x7 OR associated with a visible lesion
Stage IIa vs IIb?
IIa- Upper 2/3 of vagina
IIb- Parametrial invasion but no side-wall
Stage IIIa vs IIIb?
IIIa- Lower 1/3 of vagina but IF the parametria are involved, no sidewall extension
IIIb- Pelvic sidewall involved, and/or hydronephrosis (ureteral obstruction)
Stage IVa?
Mucosa of bladder or rectum involvement
IVb is distant mets.
Who gets CKC or simple hysterectomy?
Stage 0-I
Who gets radical hysterectomy or radiation?
Ia-2 to IIa
Who gets chemo?
IIb to IV
Prognosis rates (5 year survival)?
85-90% for Stage I
15-20% for Stage IV
Random factoid: does elevated CA-125 happen with anything besides ovarian cancer??
YES! Normal in pregnancy, endometriosis, fibroids, menses, PID, peritoneal disease, liver disease
Pap smear showed abnormal cells, did colpo. WHEN DO YOU NEED TO DO A CONIZATION (cone biopsy) OF THE CERVIX?
1) The colpo didn’t allow you to see the entire transformation zone
2) Colpo indicated possible invasive disease
3) Endocervix has a neoplasm
4) Pap is more severe than the biopsy
q116, 117 in pretest
Next step for AGUS (atypical glandular cells) result?
Colposcopy & Endocerivical curretage
Postmenopausal women should also have an endometrial sampling since the abnormality may be in the uterine cavity
