Exam 2 - Cervical cancer

Question 1

Which populations are most at risk for cervical cancer?

Answer 1

African Americans, hispanics, poor individuals

Question 2

What is the key preventative measure to prevent cervical cancer?

Answer 2

Early detection because early lesions can be removed

• Take average of 10-12 years (latent period) for HPV to progress to full blown cervical cancer

Question 3

What are the two main types of cervical cancer, and which type is most common?

Answer 3

• Squamous cell carcinoma (SCC) - most common
• Adenocarcinoma

Question 4

SCC vs adenocarcinoma - which cell type is found in the ectocervix?

Answer 4

Squamous cell carcinoma (SCC)

Question 5

SCC vs adenocarcinoma - which cell type is found in the endocervix?

Answer 5

Adenocarcinoma

Question 6

Which strain of HPV is associated with SCC?

Answer 6

HPV 16

Question 7

Which strain of HPV is associated with adenocarcinoma?

Answer 7

HPV 18

Question 8

What tissue type is associted with adenocarcinomas?

Answer 8

Columnar epithelial glandular cells

Question 9

Cervical cancer risk factors

Answer 9

• Persistent high risk HPV infection that does not clear
• Sexually active at an early age (younger than 18 years)
• Multiple or high risk sexual partners
• Smoking
• Weakened immune system
• COC use for 5+ years
• High parity (3+ full term pregnancies)
• Genetic predisposition
• DES (diethylstilbestrol) exposure

Question 10

Cervical cancer clinical manifestations

Answer 10

• Mostly asymptomatic in early disease process
• Vaginal discharge
• Abnormal vaginal bleeding (between menses, postcoital, postmenopausal)
• Late symptoms - bladder obstruction, back pain, pelvic pain, leg swelling

Question 11

Physical exam findings

Answer 11

Should perform pelvic exam, abdominal, inguinal lymph nodes, rectal exam

Cervix appears normal in early disease

• Friable, lesions/growths, hard, immobile, inguinal lymph node swelling

Question 12

Should women be screened annually for cervical cancer?

Answer 12

No

Question 13

When should routine screening for cervical cancer begin?

Answer 13

Starting at 21 years through 65 years

• Pap recommended every 3-5 years based on age (conventional slide or liquid based cytology)
• >30 years, include high-risk HPV cotest

Question 14

Screening recommendations: 21-29 years

Answer 14

• Cytology (pap smears) every 3 years
• Most HPV resolves without intervention

Question 15

Screening recommendations: ages 30-64 years

Answer 15

Cytology (pap smear) + HPV cotest every 5 years

• Increased detection of CIN 3, adenocarcinoma
• Minimizes number of colposcopies and harm

Question 16

Screening recommendations: ages 65+ years

Answer 16

Stop screening with…

• History of 3 consecutive negative pap tests OR two consecutive negative HPV tests
• No CIN 2, or higher, results within last 20 years
• Hysterectomy

Question 17

Under was circumstances should the provider NOT stop screening for cervical cancer?

Answer 17

History of CIN 2/3 or adenocarcinoma

• Continue screening for at least 20 years (even after age 65)

Question 18

How would the provider manage sexual parters of patients with cervical cancer?

Answer 18

• Partners do not need to be tested for HPV (will share HPV so partner most likely has it too)
• Encourage condom use