Cervical Neoplasia & Cervical cancer

Question 1

CIN I vs. CIN II vs. CIN III vs. carcinoma in situ vs. invasive cervical cancer

Answer 1

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

Question 2

when is CIN most likely to occur & why?

Answer 2

after menarche and after pregnancy, b/c increased ES levels during these times stimulate metaplasia at the transition zone

Question 3

what are the high-risk types of HPV correlated w/cervical cancer?

Answer 3

16, 18, 31, 45

Question 4

what types of HPV are correlated w/condylomas?

Answer 4

6 and 11

Question 5

what is ThinPrep pap smear?

Answer 5

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”

Question 6

cervical cancer screening guidelines:

Answer 6

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.

Question 7

what is ASCUS? F/u testing if found?

Answer 7

Atypical squamous cells of undtmd’ significance. Need to undergo HPV typing.

Question 8

what is ASCH? F/u testing if found?

Answer 8

atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion. Need colposcopy.

Question 9

what is LSIL

Answer 9

low-grade squamous intraepithelial lesion

Question 10

what is HSIL

Answer 10

High-grade squamous intraepith lesion

Question 11

what is SCC

Answer 11

squamous cell carcinoma

Question 12

what is reflex HPV testing?

Answer 12

if initial liquid-based pap smear was ASCUS, sample is automatically sent for HPV typing.

Question 13

what to do if reflex HPV testing is +?

Answer 13

colposcopy and cervical bx

Question 14

what to do if reflex HPV testing is - ?

Answer 14

repeat pap smear & HPV testing in 1 year

Question 15

Anything higher than ASC-US needs what?

Answer 15

colop w/cervical bx

Question 16

do you need to do HPV testing in ASC-H, LSIL, HSIL, SCC?

Answer 16

no b/c nearly all these will be +.

Question 17

cytologic dx vs. histologic dx:

Answer 17

cytologic is done on pap smears (ThinPrep)

Histologic is achieved via cervical bx w/acetowhite

Question 18

mgt of CIN I:

Answer 18

repeat pap smears w/HPV testing q6months for 1 year (most cases will spontaneously regress)

Question 19

mgt of CIN II:

Answer 19

LEEP

Question 20

mgt of CIN III:

Answer 20

LEEP

Question 21

what to do if any of repeat paps for a pt w/CIN I are abnormal?

Answer 21

colpo + bx

Question 22

mgt for CIN I that persists for + 1-2 years:

Answer 22

colpo + bx

Question 23

what is a LEEP?

Answer 23

loop electrosurgical excision procedure. Is tx for CIN II and III

Question 24

what is LLETZ?

Answer 24

large loop excision of transformation zone

Question 25

if a lesion is CIN II or III confined to ectocervix, tx = ?

Answer 25

LEEP, laser, or cryotherapy

Question 26

if a lesion is CIN II or III and involves endocervix, tx = ?

Answer 26

2-stage LEEP, or cold knife conization

Question 27

in-utero DES exposure is ass’d w/what?

Answer 27

clear-cell adenocarcinoma of cervix

Question 28

RF’s for cervical ca:

Answer 28

HPV infection w/high-risk types, smoking, high # sexual partners, early age at onset of sexual activity, immunosuppression, HIV

Question 29

sx’s of cervical ca:

Answer 29

postcoital bleeding. Also vaginal bleeding, watery discharge, pelvic pain or pressure, rectal or urinary tract sx’s.

Question 30

how is cervical ca. staged?

Answer 30

clinically (amt of invasion into adjacent strucs, presence of mets)

Question 31

stage I cervical ca =

Answer 31

confined to cervix

Question 32

stage II cervical ca =

Answer 32

extends beyond cervix but not to pelvic side walls or lower vagina

Question 33

stage III cervical ca =

Answer 33

cervix + pelvic side walls or lower 1/3 of vagina

Question 34

stage IV cervical ca =

Answer 34

involvement of bladder, pelvis, rectum, or distant mets

Question 35

tx of pre-invasive or microinvasive cervical ca =

Answer 35

hysterectomy

Question 36

tx of early-stage cervical ca =

Answer 36

radiation or radical hysterectomy w/BL LN diss’n

Question 37

diff b/w simple hysterectomy and radical hysterectomy

Answer 37

simple hysterectomy = removal of uterus alone

radical hysterectomy = removeal of uterus + parametria + upper vagina + uterosacral lig + local LNs and bv’s

Question 38

tx of later-stage (IIb-IV) cervical ca =

Answer 38

chemo + rad

Question 39

tx if its a recurrence of cervical ca:

Answer 39

if surg alone was used 1st time, can try rad.

if rad was used 1st time, pelvic extenteration surgery (removal of all pelvic organs)