EXAM #1: CERVICAL DYSPLASIA

Question 1

What is the goal of screening for cervical carcinoma?

Answer 1

Catch dysplasia (CIN) before it develops into carcinoma

Question 2

What screening for cervical dysplasia is recommended?

Answer 2

• Pap smear is gold standard

* Must include the transformation zone

Question 3

When should screening for cervical dysplasia begin?

Answer 3

21 y/o (regardless of sexual history)

Question 4

How often should screening with pap smear be performed for a woman that is 21-29 y/o?

Answer 4

Every 3 years

Question 5

What is the screening recommendation for woman that are 30-65 y/o?

Answer 5

• Pap smear (cytology) + HPV testing Q5 years

- Pap smear alone Q3 years

Question 6

When should you start screening a woman that is HIV positive?

Answer 6

At time of diagnosis even if less than 21 y/o

Question 7

When should you start screening a woman that is immunocompromised e.g. s/p solid organ transplant?

Answer 7

21 y/o

Question 8

How long should a woman that has CIN 2, 3 or cervical carcinoma continue screening?

Answer 8

Annually for 20 years even if older than 65

Question 9

When should screening stop?

Answer 9

• Woman older than 65 with negative CIN 2+

- S/p hysterectomy

Question 10

What should an abnormal pap smear be followed by?

Answer 10

1) Confirmatory colposcopy (visualization of the cervix with magnifying glass)
2) Biopsy

Question 11

What can be added to colposcopy to improved visualization?

Answer 11

Acetic acid

Question 12

How are more advanced changes confirmed with colposcopy and biopsy treated?

Answer 12

1) Cryotherapy
2) Excisional via “LEEP” i.e. loop electrocautery*
3) Cone biopsy

*Can cause long-term cervical complications

Question 13

What is the most common subtype of cervical carcinoma?

Answer 13

Squamous cell carcinoma

Question 14

What subtype of cervical carcinoma accounts for the minority of cases?

Answer 14

Adenocarcinoma

Question 15

How does SCC compare to adenocarcinoma clinically?

Answer 15

1) Adenocarcinoma is more aggressive

2) Associated with “skip lesions”

Question 16

What are the clinical manifestations of cervical carcinoma?

Answer 16

Early stages are asymptomatic but symptoms of more advanced cases include:

• Vaginal bleeding
• Postcoital bleeding
• Cervical discharge
• Malodrous

Question 17

How does cervical carcinoma spread?

Answer 17

1) Local invasion/ direct extension

2) Lymphatic

Question 18

What are the advanced complications of cervical carcinoma?

Answer 18

1) Extension through the anterior uterine wall to the bladder –blocking the ureters
2) Hydronephorosis
3) Postrenal failure

*Can also cause venous blockage and resulting unilateral edema

Question 19

What is the first lymph node that will be affected by cervical carcinoma?

Answer 19

Paracervical

Question 20

How is cervical carcinoma staged?

Answer 20

Clinically

Question 21

What is indicated for the pre-treatment evaluation of cervical carcinoma?

Answer 21

1) Physical examine
2) Routine blood work
3) CXR
4) IVP i.e. intravenous pyelogram (evaluation of ureter flow)

Question 22

What is the treatment for Stage 1A1 carcinoma?

Answer 22

Cold-knife biopsy or hysterectomy

*Low risk of pelvic node involvement

Question 23

What is the treatment for Stage 1A2 carcinoma?

Answer 23

Radical hysterectomy

*15% risk of pelvic node involvement

Question 24

What is the treatment for Stage 2, 3, and 4 carcinoma?

Answer 24

Radiation and chemotherapy

Question 25

What is a radical hysterectomy?

Answer 25

• Resection of the uterus and cervix
• Resection of the upper 2/3 of the vagina
• Resection of the pelvic side wall
• Pelvic node dissection
• Sampling of aortic nodes

Question 26

What is Brachytherapy?

Answer 26

Intracavity radiation

Question 27

How is HPV prevented?

Answer 27

Vaccination– 9 valent recent approved

*Must be given before sexually active AND pap-smears still indicated