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Clin Med III exam III > Dysplastic and Malignant Disorders of Cervix > Flashcards

Dysplastic and Malignant Disorders of Cervix Flashcards

1
Q

What is the major etiologic agent of cervical pre-cancerous lesions

A

HPV

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2
Q

What are the two major factors associated with development of cervical intraepithelial neoplasia and cervical cancer

A
  • HPV types

- Age and persistence

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3
Q

Low risk HPV types

A

6 and 11

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4
Q

High risk HPV types

A

16 (more prevalent) and 18

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5
Q

HPV 16 and 18 cause what type of cancer

A
  • squamous cell carcinoma

- adenocarcinoma

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6
Q

The likelihood of HPV persistence is related to what

A
  • older age
  • duration of infection
  • high oncogenic HPV subtype
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7
Q

What is the transformation zone

A

the border between the stratified squamous epithelium of the ectocervix and the columnar epithelium of the endocervix

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8
Q

Where does cervical neoplasia originate

A

the transformation zone (t-zone)

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9
Q

Three clinical scenarios that can follow an acute HPV infection

A
  • latent infection
  • active infection
  • neoplastic transformation
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10
Q

Latent HPV infection

A

ifection without physical, cytologic of histologic manifestations

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11
Q

Active HPV infection

A

HPV undergoes replication but does not integrate into the host genome

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12
Q

Neoplastic transformation HPV infection

A

the virus persists into the cytoplasm and integrates into the host genome

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13
Q

What is an important factor in the early stages following HPV infection

A

susceptibility to oncogenic HPV types, determined by the host immune system

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14
Q

Other factors to that contribute to the pathogenesis of HPV

A
  • immunosuppression
  • cigarette smoking
  • herpes/chlamydia
  • OCP
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15
Q

Two types of testing for HPV

A
  • HPV DNA testing

- HPV RNA testing

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16
Q

What does HPV RNA testing look for

A

expression of E6 and/or E7 RNA (oncoproteins)

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17
Q

What is ASC (2 types)

A

atypical squamous cells

  • can be of undetermined significance (ASC-US)
  • or cannot exclude high grade squamous intraepithelial lesions (ASC-H)
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18
Q

What are the two types of classification systems for cervical neoplasia

A
  • LAST system

- Bethesda classification system

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19
Q

What can abnormal cytology findings be described as

A
  • atypical squamous cells of undetermined significance
  • low grade squamous intraepithelial lesions
  • high grade squamous intraepithelial lesions
  • atypical glandular cells of undetermined significance
  • invasive cervical cancer
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20
Q

Histological terms for cervical intraepithelial neoplasia (CIN)

A
  • CIN1 (low grade)
  • CIN 2,3 (high grade)
  • CIN 3 includes carcinoma in situ
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21
Q

What is cervical cancer screening co-testing

A

testing with both cervical cytology (pap) and HPV infection

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22
Q

What is reflex HPV testing

A

collecting a specimen for HPV testing when PAP is done but preforming the HPV test if cytology results are ASC-US

23
Q

What is cervical intraepithelial neoplasia

A

premalignant condition of the uterine cervix

24
Q

Risk factors for cervical cancer

A
  • early onset of sexual activity
  • multiple sexual partners
  • high risk sexual partner
  • hx of STI
  • hx of vulvar or vaginal squamous intraepithelial neoplasia or cancer
  • immunosuppression
25
Q

What are the 4 major steps in cervical cancer development

A
  1. oncogenic HPV infection of the metaplastic epithelium at the cervical transformation
  2. persistance of HPV infection
  3. progression of a clone of epithelial cells from persistent viral infection to pre cancer
  4. development of carcinoma and invasion through the basement membrane
26
Q

Direct extension of cervical cancer goes where?

A
  • uterine corpus
  • vagina
  • peritoneal cavity
  • bladder
  • rectum
27
Q

Clinical manifestations of cervical cancer

A
  • irregular or heavy vaginal bleeding

- postcoital bleeding

28
Q

Women with a visible cervical lesion, symptoms, abnormal cervical cytology should undergo what

A

colposcopy with directed biopsy

29
Q

When is cervical conization necessary

A

if malignancy is suspected but is not found with directed cervical biopsies

30
Q

Routine lab evaluations for cervical cancer

A
  • CBC
  • LFTs
  • renal function test
  • urine
31
Q

FIGO system for cervical cancer staging is based mostly on ___

A

physical examination

32
Q

FIGO system does not include ___

A

stage 0 (TNM does)

33
Q

Primary CIN prevention

A
  • pap screening

- HPV vaccination

34
Q

If pregnant with ASC-US colposcopy can be deferred until ____

A

six weeks postpartum

35
Q

If pregnant with ASC-H

A

colposcopy should be preformed and should not be deferred

36
Q

What should not be done during pregnancy

A

endocervical curettage

37
Q

At what ages should pap smear be done

A

21-65 years old

38
Q

Location of pap smear

A

transformation zone

39
Q

Types of equiptment to collect pap samples

A
  • ayre spatula (conventional smears)
  • cervix brush
  • cytobrush (no ectocervical sample)
40
Q

What is endocervical curettage

A

inseritng a small, sharp, scoop shaped instrument into the cervical canal to obtain tissue

41
Q

When is endocervical curettage done

A

when endometrial or cervical cancer is suspected or needs to be ruled out

42
Q

if 25 or older with HPV negative ASC-US—>

A

co testing in three years

43
Q

If 25 years or older with HPV-positive ASC-US—>

A

colposcopy

44
Q

If 21-24 w/ negative cytology, ASC-US or LSIL—>

A

repeat pap in 12 months for 2 years

45
Q

If 21-24 w/ ASC-H, HISL or AGC—>

A

colposcopy

46
Q

If 25 or older and no lesion or CIN1 on colposcopy—>

A

co-testing in 12 and 24 months

47
Q

If 25 years or older and CIN 2,3 on colposcopy–>

A

treat! (LEEP)

48
Q

Evaluation of ASC-H in females 21-24—>

A

cytology and colposcopy every 6 months for 12 months

49
Q

What do you do next after evaluating a 21 to 24 year old with ASC-H

A

if cytology and colposcopy are neg—> co testing after 1 year

abnormality persists for 1 year–> repeat biopsy

abnormality persists for 2 years—> treat!

50
Q

Cervical cancer treatments for women with microscopic disease

A
  • extrafascial hysterectomy

- cone biopsy

51
Q

What is an extrafascial hysterectomy

A

fascia of the cervix and lower uterine segment is removed along with the uterus

52
Q

Candidates for radical hysterectomy

A

women with a tumor that is confined to the cervix, uterus or upper third of the vaginal with no lymph node metastasis

53
Q

Candidates for chemo-radiation

A

women with local extension (low two thirds of the vagina or bladder) or lymph node metastasis

54
Q

Candidates for full dose chemotherapy alone

A

women with widely metastatic disease

Clin Med III exam III (10 decks)

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