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Clin Med 3- Exam 3 > Dysplastic and Malignant Disorders of the Cervix > Flashcards

Dysplastic and Malignant Disorders of the Cervix Flashcards

1
Q

T/F: HPV is necessary for the development of cervical neoplasia, but not alone sufficient in causing these disorders.

A

True: necessary, but other co-factors needed

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2
Q

What are the 2 major factors associated with development of cervical intraepithelial neoplasia (CIN) and cervical cancer?

A

(1) HPV types

(2) age and persistence

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3
Q

What are the 2 low-risk types of HPV?

A

6 and 11

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4
Q

What are the 2 high-risk types of HPV? And which type is more prevalent in squamous cell carcinoma?

A

16 and 18; 16 more prevalent in squamous cell carcinoma

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5
Q

The likelihood of HPV persistence is related to what 3 factors?

A

(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)

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6
Q

What is the transformation zone (T-zone)?

A

The border b/w the stratified squamous epithelium of the ectocervix and the columnar epithelium of the endocervix

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7
Q

What is the T-zone regarded as?

A

The site of carcinogenesis by infection w/oncogenic subtypes of HPV

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8
Q

What is the significance of the T-zone?

A

Cervical neoplasia originates w/in the T-zone

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9
Q

What is the difference between neoplastic transformation and active HPV infection?

A

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

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10
Q

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

A

The individual’s susceptibility to oncogenic HPV types, which is determined by the host’s immune system

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11
Q

What are 4 cofactors in the pathogenesis of HPV?

A

(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

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12
Q

What does E6 RNA do?

A

Prevents p53 from making damaged cells commit suicide

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13
Q

What does E7 RNA do?

A

Binds to Rb and prevents it from stopping damaged cells from growing

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14
Q

What is ASC-US?

A

Atypical squamous cells of undetermined significance

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15
Q

What is ASC-H?

A

Atypical squamous cells: cannot exclude high-grade squamous intraepithelial lesion

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16
Q

What is cervical cancer screening co-testing?

A

Testing w/both cervical cytology (Pap test) and high-risk HPV infection

17
Q

What is reflex HPV testing?

A

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

18
Q

What is cervical intraepithelial neoplasia (CIN)?

A

A premalignant condition of the uterine cervix

19
Q

T/F: cervical cancer is the most preventable cancer.

A

True (b/c of cervical screenings and HPV vaccines)

20
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) 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

21
Q

What are 3 routes of cervical cancer spread?

A

(1) direct extension (may involve uterine corpus, vagina, peritoneal cavity, bladder, rectum)
(2) lymphatic
(3) hematogenous dissemination

22
Q

What are 2 clinical manifestations of cervical cancer?

A

(1) irregular or heavy vaginal bleeding

2) postcoital bleeding (very specific finding

23
Q

What are the 4 tests for dx of cervical cancer and when is each used?

A

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

24
Q

What tumor staging system is used for cervical cancer?

A

FIGO: International Federation of Gynaecology and Obstetrics (a clinical staging system)

25
Q

Why is accurate pretreatment staging of cervical cancer critical?

A

It determines therapy and prognosis

26
Q

What are 2 major prognostic factors affecting survival for cervical cancer?

A

(1) disease stage

(2) lymph node status

27
Q

For pregnant women with ASC-US, what is the recommendation on when to do a colposcopy?

A

Deferred until 6 weeks postpartum

28
Q

For pregnant women with ASC-H, what is the recommendation on when to do a colposcopy?

A

Performed right away, not deferred

29
Q

When should a cervical biopsy be done for pregnant cervical cancer pts?

A

Only if a high-grade abnormality is suspected

30
Q

What are the Pap smear indications for women under 21?

A

Not indicated (low prevalence of lesions will progress to cancer)

31
Q

What are the Pap smear indications for women 21-29?

A

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

32
Q

How often is co-testing recommended for 30 years and older?

A

Every 5 years for > 30 years old

33
Q

When are Pap smears discontinued/no longer recommended for women?

A

> 65 yrs w/hx of negative tests

34
Q

Once Pap smears are discontinued for a pt, should they resume-and if so for what reason?

A

NO: should not resume for any reason, even a new sex partner, if they have hx of negative results

Clin Med 3- Exam 3 (4 decks)

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