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Women's Health 1 > Clin Med - Uterine Cervix & Corpus > Flashcards

Clin Med - Uterine Cervix & Corpus Flashcards

1
Q

What is the MCC of cervix cancer?

A

HPV - human papilloma virus

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2
Q

What are the risk factors for HPV?

A
  • Multiple sexual partners
  • Young age at coitarche
  • High parity
  • -First baby before the age of 20
  • Immunosuppression
  • Cigarette smoking
  • -Byproducts of smoking appear in the cervical mucous
  • Failure to participate in regular screening
  • Persistent HPV infection with high risk serotypes (HPV 16, 18)
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3
Q

Define koilocytosis

A

presence of koilocytes in a specimen

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4
Q

Define koilocyte

A

a squamous epithelial cell that has undergone morphologic changes as a result of HPV infection

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5
Q

What do HPV-infected cells look like under the microscope?

A
  1. Enlarged nuclei
  2. Darker than normal staining pattern in nucleus – hyperchromasia
  3. perinuclear halo – clear area around the nucleus
  4. irregularity of nuclear membrane
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6
Q

What are the screening tests for cervical cancer?

A
  • pap test

- HPV testing

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7
Q

Characteristics of pap test

A
  • most effective screening test in modern medicine
  • not a screening test for CANCER
  • pap tests are designed to find subclinical disease, but cancer is often found by them
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8
Q

Which serotype is HPV testing looking for?

A

High risk serotypes: 16, 18, 31, 33

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9
Q

Which part of the cervix are we looking for with colposcopy?

A

The transformation zone

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10
Q

Cervical Intraepithelial Neoplasm (CIN)

-etiology

A
  • Obtained from colposcopic directed biopsy
  • Premalignant lesions
  • HPV infection:
  • -Extremely common
  • -Asymptomatic
  • -Mostly transient
  • -Persistence increases risk for premalignant lesion
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11
Q

Management of CIN

A
  • Expectant with surveillance vs. treatment
  • -Cervical cytology findings
  • -Colposcopic impression
  • -Cervical biopsy results

Patient characteristics

  • Age
  • Pregnancy
  • Likelihood of compliance
  • Smoking
  • Immunocompromised state
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12
Q

Histology of cervical cancers

-list the most prevalent

A
  • Squamous cell (80%)
  • Adenocarcinoma (15%)
  • Adenosquamous
  • Neuroendocrine or small cell carcinoma (rare)
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13
Q

When is peak incidence of cervical cancers?

A

Peak incidence is 45 years

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14
Q

List the locations of metastasis of cervical cancer

-direct extension

A
  • Parametria/Broad Ligament
  • Bladder
  • Rectum
  • Vagina
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15
Q

List the locations of metastasis of cervical cancer

-lymphatics

A
  • Pelvic
  • Para-aortic
  • Supraclavicular
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16
Q

What is determined via clinical staging?

A
  • prognosis

- treatment planning

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17
Q

Staging of cervical cancer

-urinary tract

A
  • Cystoscopy
  • Renal ultrasound
  • Intravenous pyelogram
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18
Q

Staging of cervical cancer

-rectum

A
  • Proctoscopy
  • Gastrograffin enema
  • Flexible sigmoidoscopy
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19
Q

What is the other modality for staging of cervical cancer?

A

Chest xray (looking for metastasis)

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20
Q

Treatment of Early Stage Cervical Cancer

A
  • Radical hysterectomy
  • Pelvic and para-aortic lymphadenectomy
  • Stage IA2-IB2

+/- adjuvant radiation based on risk factors

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21
Q

Treatment of Advanced Stage Cervical Cancer

A
  • Combination of external and internal radiation
  • Whole pelvic radiation with brachytherapy
  • Cisplatin given at a low dose as radiation sensitizing agent
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22
Q

What is the Benign Neoplasm of Uterine Cervix?

A

Endocervical Polyps

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23
Q

Etiology of endocervical polyps

A
  • Common, 2-5% all women
  • Benign, exophytic neoplasms
  • Arise in endocervical canal
  • Irregular bleeding
  • Tx: excision in outpatient setting
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24
Q

Define endometriosis

A
  • presence of extrauterine endometrial glands AND stroma

- a benign pathology of the uterine corpus

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25
Q

Etiology of endometriosis

A
  • Common
  • Implants are hormonally responsive meaning growth and maintenance of implants dependent upon estrogen – so unusual to see in post-menopausal women
  • Sx: dysmenorrhea, pelvic pain, and infertility OR pts asymptomatic
26
Q

List the Clinical Features of Endometriosis

A
  • Dysmenorrhea
  • Dyspareunia
  • Infertility
  • Bowel/bladder symptoms
27
Q

Endometriosis on exam + diagnosis

A
  • Tenderness
  • Nodules
  • Fixed uterus/adnexae
  • Dx - biopsy
28
Q

Tx of endometriosis

A

Empiric trial:

  • NSAIDS
  • Oral contraceptives
  • GnRH agonist

Surgical management based on patient goals:

  • Infertility
  • Pain
29
Q

Define adenomyosis

A

Endometrial glands and stroma are present within the myometrium (the muscular structure of the uterus)

30
Q

Adenomyosis etiology

A
  • Globular enlargement
  • Can present with dysmenorrhea and menorrhagia
  • Endometrial biopsy - normal
  • Pt often asymptomatic
31
Q

Diagnosis & Treatment of Adenomyosis

A

Diagnosis:

  • Histology
  • MRI

Treatment:
+/- hormonal manipulation
-Hysterectomy

32
Q

Define endometrial polyps

A

Hyperplastic overgrowth of endometrial glands and stroma

33
Q

Etiology of endometrial polyps

A
  • Occurs in reproductive age women
  • Pt presents with abnormal bleeding
  • *Generally benign
  • Can be caused by Tamoxifen
  • Tx is polypectomy
34
Q

Define leiomyomas

A

Benign smooth muscle neoplasm

**very common

35
Q

Etiology of leiomyomas

A
  • Occurs in reproductive age women
  • Pt presents with abnormal uterine bleeding, pressure, pain, infertility
  • Can result in large, irregularly shaped uterus
36
Q

Leiomyomas are described according to…

A
  • location*
  • Intramural
  • Submucosal
  • Subserosal
  • Intracavitary
  • Pedunculated (these can torse and cause high amount of pain)
37
Q

What should you consider when thinking of tx for leiomyomas?

A
  • Severity of symptoms?
  • Size of neoplasm?
  • Location of neoplasm?
  • Patient age?
  • Reproductive plans?
38
Q

Treatment of leiomyomas

A
  • Expectant management
  • Medical management
  • -Hormonal therapy
  • -NSAIDs
  • Uterine artery embolization
  • Surgical
  • -Hysterectomy
  • -Myomectomy
39
Q

Define myomectomy

A

Surgical procedure to remove myomas or fibroids (aka leiomyomas)

40
Q

Define endometrial hyperplasia

A

Increased proliferation of endometrial glands

41
Q

Etiology of endometrial hyperplasia

A
  • Precursor to carcinoma

- Seen in pre and postmenopausal women***

42
Q

Clinical presentation of endometrial hyperplasia

A
  • Postmenopausal bleeding
  • Anovulatory premenopausal women
  • Abnormal uterine bleeding
43
Q

What are the risk factors for endometrial hyperplasia or cancer?

A
  • prolonged estrogen seen in these conditions:
  • PCOS
  • Obesity
  • Exogenous (ERT or Tamoxifen)
  • Granulosa cell tumor of ovary
  • Over 40 with abnormal uterine bleeding
  • Under 40 with abnormal uterine bleeding and risk factors
  • AGUS on cytology
  • Hereditary nonpolyposis CRC
44
Q

Evaluation of endometrial hyperplasia

-normal vs. abnormal

A

Normal
-Secretory or proliferative endometrium

Abnormal

  • Simple hyperplasia (with or without atypia)
  • Complex hyperplasia (with or without atypia)
  • Malignancy
45
Q

Classification of endometrial hyperplasia

-simple hyperplasia

A

Histology
-Mild increase in gland to stroma ratio

Progression to cancer
-1%

46
Q

Classification of endometrial hyperplasia

-complex hyperplasia

A

Histology
-Increased number and size of endometrial glands, marked gland crowding, and branching of glands

Progression to cancer
-3%

47
Q

Classification of endometrial hyperplasia

-simple hyperplasia with atypia

A

Histology
-Glands have appearance of simple hyperplasia with cytologic atypia; uncommon

Progression to cancer
-8%

48
Q

Classification of endometrial hyperplasia

-complex hyperplasia with atypia

A

Histology
-Considerable overlap with grade 1 adenocarcinoma

Progression to cancer
-29%

49
Q

Prevention of endometrial hyperplasia

A
  • OCPs
  • Levonorgestrel IUD (5 years)
  • Intermittent progestins (10 days/month)
  • Depot medroxyprogesterone acetate (150 mg IM) Q 3 months
50
Q

Treatment of endometrial hyperplasia

A
  • Progestins
  • Megestrol acetate 80-160 mg -PO BID
  • Re-biopsy

*Surgery

51
Q

What is the MC gyn cancer?

A

Endometrial carcinoma

52
Q

Clinical presentation of endometrial carcinoma

A
  • Postmenopausal bleeding
  • AGUS on Pap cytology
  • Size of uterus usually not altered
53
Q

When is endometrial carcinoma generally diagnosed?

A

at early stage with endometrial biopsy

54
Q

How can you distinguish endometrial carcinoma from leiomyoma?

A

Endometrial carcinomas are not usually markedly enlarged tumors whereas leiomyomas are big!

55
Q

Type I Endometrial Cancer

A
  • *estrogen dependent
  • precursor: endometrial hyperplasia
  • % cases = 90%
  • biologic behavior: indolent, spread via lymphatics
  • histology: endometrioid, well differentiated
  • age: 55-65
  • clinical setting: unopposed estrogen, obesity, HTN, diabetes
56
Q

Type II Endometrial Cancer

A
  • *estrogen independent
  • precursor: endometrial intraepithelial carcinoma
  • % cases: 10%
  • biologic behavior: aggressive; intraperitoneal and lymphatic spread
  • histology: serous, clear cell; poorly differentiated
  • age: 65-75
  • clinical setting: thin, atrophic endometrium
57
Q

Tx of endometrial cancer

-surgically staged

A
  • Hysterectomy
  • Bilateral salpingoophorectomy
  • Pelvic and para-aortic lymphadenectomy
  • Pelvic cytology
58
Q

Tx of endometrial cancer

-other options

A
  • Surgery alone (early stage)

- Surgery + adjuvant radiation and/or chemotherapy (locally advanced)

59
Q

Poor operative candidates for tx of endometrial cancer include…

A

Those who have undergone:

  • Hormonal therapy
  • Radiation
  • Chemotherapy
60
Q

Etiology of leiomyosarcomas

A
  • Rare
  • Peak incidence (40-60 years)
  • Generally identified post-hysterectomy
  • Surgically staged
  • Adjuvant chemotherapy
  • Gemcitabine
  • Docetaxel
  • Hematogenous metastasis
  • -Chest, brain
  • 5 year survival 30-40%
61
Q

How are leiomyosarcomas distinguished from leiomyomas?

A
  • Nuclear atypia
  • Mitotic index (10 or more mitoses per hpf)
  • Zonal necrosis
  • spindle cell neoplasm

Women's Health 1 (17 decks)

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