Dysplastic and Malignant Disorders of the Cervix Flashcards
T/F: HPV is necessary for the development of cervical neoplasia, but not alone sufficient in causing these disorders.
True: necessary, but other co-factors needed
What are the 2 major factors associated with development of cervical intraepithelial neoplasia (CIN) and cervical cancer?
(1) HPV types
(2) age and persistence
What are the 2 low-risk types of HPV?
6 and 11
What are the 2 high-risk types of HPV? And which type is more prevalent in squamous cell carcinoma?
16 and 18; 16 more prevalent in squamous cell carcinoma
The likelihood of HPV persistence is related to what 3 factors?
(1) older age (>55yrs)
(2) duration of infection: longer the infection has been recognized, the longer it will take to clear
(3) high oncogenic HPV subtypes (more likely to persist than low oncogenic types)
What is the transformation zone (T-zone)?
The border b/w the stratified squamous epithelium of the ectocervix and the columnar epithelium of the endocervix
What is the T-zone regarded as?
The site of carcinogenesis by infection w/oncogenic subtypes of HPV
What is the significance of the T-zone?
Cervical neoplasia originates w/in the T-zone
What is the difference between neoplastic transformation and active HPV infection?
Neoplastic transformation: the virus can persist in the cytoplasm and integrate into the host genome
Active infection: HPV undergoes replication, but not integration into the genome
What is an important factor in the early stages following HPV infection?
The individual’s susceptibility to oncogenic HPV types, which is determined by the host’s immune system
What are 4 cofactors in the pathogenesis of HPV?
(1) immunosuppression
(2) cigarette smoking: breakdown products of cigarette smoke are concentrated in cervical mucus causing cellular abnormalities in cervical epithelium and a dec in local immunity
(3) herpes and chlamydia
(4) oral contraceptives
What does E6 RNA do?
Prevents p53 from making damaged cells commit suicide
What does E7 RNA do?
Binds to Rb and prevents it from stopping damaged cells from growing
What is ASC-US?
Atypical squamous cells of undetermined significance
What is ASC-H?
Atypical squamous cells: cannot exclude high-grade squamous intraepithelial lesion
What is cervical cancer screening co-testing?
Testing w/both cervical cytology (Pap test) and high-risk HPV infection
What is reflex HPV testing?
The collection of a specimen for HPV testing when the cytology sample is collected, but performing the HPV test only if the cytology results are ASC-US
What is cervical intraepithelial neoplasia (CIN)?
A premalignant condition of the uterine cervix
T/F: cervical cancer is the most preventable cancer.
True (b/c of cervical screenings and HPV vaccines)
What are the 4 major steps in cervical cancer development?
(1) oncogenic HPV infection of the metaplastic epithelium at the cervical transformation→ (2) persistence of the 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
What are 3 routes of cervical cancer spread?
(1) direct extension (may involve uterine corpus, vagina, peritoneal cavity, bladder, rectum)
(2) lymphatic
(3) hematogenous dissemination
What are 2 clinical manifestations of cervical cancer?
(1) irregular or heavy vaginal bleeding
2) postcoital bleeding (very specific finding
What are the 4 tests for dx of cervical cancer and when is each used?
1) Physical exam: pelvic exam for any woman w/sx suggestive of cervical cancer
2) Cervical cytology: principal method for cervical cancer screening
3) Cervical biopsy and colposcopy: colposcopy w/directed biopsy for women w/o visible lesion, symptomatic women w/o visible lesion, and those w/abnormal cervical cytology
4) Cervical colonization: necessary if malignancy suspected and not found w/cervical biopsy
What tumor staging system is used for cervical cancer?
FIGO: International Federation of Gynaecology and Obstetrics (a clinical staging system)
Why is accurate pretreatment staging of cervical cancer critical?
It determines therapy and prognosis
What are 2 major prognostic factors affecting survival for cervical cancer?
(1) disease stage
(2) lymph node status
For pregnant women with ASC-US, what is the recommendation on when to do a colposcopy?
Deferred until 6 weeks postpartum
For pregnant women with ASC-H, what is the recommendation on when to do a colposcopy?
Performed right away, not deferred
When should a cervical biopsy be done for pregnant cervical cancer pts?
Only if a high-grade abnormality is suspected
What are the Pap smear indications for women under 21?
Not indicated (low prevalence of lesions will progress to cancer)
What are the Pap smear indications for women 21-29?
Testing w/cytology alone every 3 years; co-testing should not be performed for women under 30 yrs; reflex HPV testing for ASC-US only
How often is co-testing recommended for 30 years and older?
Every 5 years for > 30 years old
When are Pap smears discontinued/no longer recommended for women?
> 65 yrs w/hx of negative tests
Once Pap smears are discontinued for a pt, should they resume-and if so for what reason?
NO: should not resume for any reason, even a new sex partner, if they have hx of negative results
