Cervical Neoplasia & Cervical cancer Flashcards
CIN I vs. CIN II vs. CIN III vs. carcinoma in situ vs. invasive cervical cancer
CIN I = dysplasia involving < 1/3 of epithelium
CIN II = dysplasia involving 1/3-2/3 of epithelium
CIN III = dysplasia involving > 2/3 of epithelium
carcinoma in situ = entire epith is dysplastic, no invasion thru BM
invasive cervical cancer = invaded thru BM
when is CIN most likely to occur & why?
after menarche and after pregnancy, b/c increased ES levels during these times stimulate metaplasia at the transition zone
what are the high-risk types of HPV correlated w/cervical cancer?
16, 18, 31, 45
what types of HPV are correlated w/condylomas?
6 and 11
what is ThinPrep pap smear?
endocervical sample is placed in liquid which is put on a slide. Good b/c fewer cells are req’d and cells don’t clump together. Fewer pap smears are considered nondiagnostic 2/2 “insufficient material”
cervical cancer screening guidelines:
start at 21 y/o. Screen q3y, or q5y w/HPV testing starting at age 30. Stop screening at age 35. Don’t need to have pap smears if hysterectomy w/removal of cervix. But if its a supracervical hysterectomy, need to still have pap smears.
what is ASCUS? F/u testing if found?
Atypical squamous cells of undtmd’ significance. Need to undergo HPV typing.
what is ASCH? F/u testing if found?
atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion. Need colposcopy.
what is LSIL
low-grade squamous intraepithelial lesion
what is HSIL
High-grade squamous intraepith lesion
what is SCC
squamous cell carcinoma
what is reflex HPV testing?
if initial liquid-based pap smear was ASCUS, sample is automatically sent for HPV typing.
what to do if reflex HPV testing is +?
colposcopy and cervical bx
what to do if reflex HPV testing is - ?
repeat pap smear & HPV testing in 1 year
Anything higher than ASC-US needs what?
colop w/cervical bx
do you need to do HPV testing in ASC-H, LSIL, HSIL, SCC?
no b/c nearly all these will be +.
cytologic dx vs. histologic dx:
cytologic is done on pap smears (ThinPrep)
Histologic is achieved via cervical bx w/acetowhite
mgt of CIN I:
repeat pap smears w/HPV testing q6months for 1 year (most cases will spontaneously regress)
mgt of CIN II:
LEEP
mgt of CIN III:
LEEP
what to do if any of repeat paps for a pt w/CIN I are abnormal?
colpo + bx
mgt for CIN I that persists for + 1-2 years:
colpo + bx
what is a LEEP?
loop electrosurgical excision procedure. Is tx for CIN II and III
what is LLETZ?
large loop excision of transformation zone
if a lesion is CIN II or III confined to ectocervix, tx = ?
LEEP, laser, or cryotherapy
if a lesion is CIN II or III and involves endocervix, tx = ?
2-stage LEEP, or cold knife conization
in-utero DES exposure is ass’d w/what?
clear-cell adenocarcinoma of cervix
RF’s for cervical ca:
HPV infection w/high-risk types, smoking, high # sexual partners, early age at onset of sexual activity, immunosuppression, HIV
sx’s of cervical ca:
postcoital bleeding. Also vaginal bleeding, watery discharge, pelvic pain or pressure, rectal or urinary tract sx’s.
how is cervical ca. staged?
clinically (amt of invasion into adjacent strucs, presence of mets)
stage I cervical ca =
confined to cervix
stage II cervical ca =
extends beyond cervix but not to pelvic side walls or lower vagina
stage III cervical ca =
cervix + pelvic side walls or lower 1/3 of vagina
stage IV cervical ca =
involvement of bladder, pelvis, rectum, or distant mets
tx of pre-invasive or microinvasive cervical ca =
hysterectomy
tx of early-stage cervical ca =
radiation or radical hysterectomy w/BL LN diss’n
diff b/w simple hysterectomy and radical hysterectomy
simple hysterectomy = removal of uterus alone
radical hysterectomy = removeal of uterus + parametria + upper vagina + uterosacral lig + local LNs and bv’s
tx of later-stage (IIb-IV) cervical ca =
chemo + rad
tx if its a recurrence of cervical ca:
if surg alone was used 1st time, can try rad.
if rad was used 1st time, pelvic extenteration surgery (removal of all pelvic organs)
