Female Genital 1

Question 1

What is necessary for the development of most cervical cancer?

Answer 1

HPV- high risk HPVs are the single most important factor in cervical oncogenesis

Question 2

What are the two most high risk HPV types?

Answer 2

16 and 18

31,33,45,51

Question 3

Viral proteins E6 and E7 inactivate what?

Answer 3

p53 and Rb respectively

Question 4

In most cases the viral DNA is maintained separately from the host DNA as an episome, but what happens in cases of malignant transformation?

Answer 4

viral DNA is integrated into the host genome

Question 5

What percent of HPV infections are transient?

Answer 5

90%

• not detectable within a few years
• women whose infections persist are at greatest risk of developing cervical lesions

Question 6

What percentage of men and women will be infected with HPV at some time?

Answer 6

80%

Question 7

Is HPV 16 or 18 more common in cervical cancer cases?

Answer 7

16

Question 8

Besides HPV, what are 4 other additional risk factors to cervical carcinoma?

Answer 8

smoking
diet
combined oral contraceptives
immunosuppression

Question 9

T-F cervical cancer is the #1 cause of cancer death in women in the US?

Answer 9

False- 14th it was number 1 in 1950

Question 10

What 2 ways does screening reduce deaths?

Answer 10

1. increasing the detection of invasive cancer at early stages
2. increasing the detection of pre invasive lesions

Question 11

age 21-29 women need what PAP protocol? 30-65? >65?

Answer 11

1. pap every 3 yrs
2. pap and HPV co test every 5 years or pap every 3 years
3. no testing if adequate prior negative testing

Question 12

Where do most cervical carcinomas arise?

Answer 12

at or near the squamocolumnar junction

Question 13

What is a key benefit of the liquid-based pap test? do they have a lower or higher false negative/positive rate?

Answer 13

can also perform HPV testing on the residual sample

can make multiple slides too
LOWER FALSE NEGATIVE RATE BUT A HIGHER FALSE POSITIVE RATE

Question 14

Why is regular screeing crucial for paps? what type of cancer is it best at preventing? can they detect pre cancer lesions? what are they not great at preventing?

Answer 14

1. increases sensitivity
2. cervical squamous carcinoma
3. yes
4. adenocarcinomas or any other types of cancers in that area

Question 15

What type of cell does HPV infect? where are they most accessible?

Answer 15

1. basal cells

2. ssquamocolumnar junction

Question 16

How do we obtain a histological biopsy of cervix?

Answer 16

colposcopy

Question 17

What are we looking for in a pap test?

Answer 17

nuclear changes that are surrogate marker for the presence of HPV

Question 18

CINI represents how thick the basal layer ascends? CINII? CINIII?

Answer 18

1. lower third
2. middle third
3. upper third/full thickness (severe dysplasia vs. CIS)

Question 19

What are the 4 key diagnosis made from pap tests?

Answer 19

1. NILM (negative for intraepithelial lesion or malignancy)
2. ASCUS- (atypical squamous cells of undetermined significance)
3. LSIL
4. HSIL

Question 20

Where do ASCUS cells fall into the diagram of histological classifications?

Answer 20

can fall into any of the diagnoses

therefore, if there is a ASCUS finding then HPV test will be done to look for HPV high risk types

Question 21

What are the hallmark of low-grade SIL? describe them?

Answer 21

Koilocytes- which are squamous cells with enlarged nuclei, low N:C ratio, crisp perinuclear clearing (indicative of presence of HPV)

Question 22

What do we see in colposcopy of high grade SIL (HSIL)/CINII

Answer 22

More dense acetowhite areas and punctations due to abnormal blood vessels. GETS WORSE AND MORE EXTENSIVE FOR WORSE LESIONS

Question 23

Do we still see koliocytes in CIN3?

Answer 23

No

Question 24

In pap of HSIL, are single cells often present?

Answer 24

Yes…unlike LSIL and lesser grade lesions

Question 25

What is the management of women with HSIL?

Answer 25

immediate loop electrosurgical excision or colposcopy with assessment

Question 26

What is the goal of excisional procedures like the LEEP or cold knife?

Answer 26

remove all HPV related lesions with clear margins

Question 27

What is the most common type of cervical carcinoma?

Answer 27

squamous cell 75%

adenocarcinoma 15%

Question 28

What are the strict requirements for micro invasive carcinoma?

Answer 28

less than 3mm depth and 7mm horizontal extent

Question 29

Most patients with carcinoma of cervix have what symptom? what other symptoms are common?

Answer 29

1. NONE!

2. post-coital bleeding, vaginal bleeding, vaginal discharge

Question 30

What is a strong sign of invasive squamous cell carcinoma?

Answer 30

desmoplasia

Question 31

What is difficult about cervical adenocarcinoma?

Answer 31

more difficult to sample on pap and also more difficult to interpret for pathologist

Question 32

What do we see histologically in cervical adenocarcinoma in situ?

Answer 32

glands with pseudo stratified hyper chromatic nuclei with apoptoses and mitoses

Question 33

What do we see histologically in invasive cervical adenocarcinoma

Answer 33

malignant haphazard glands with irregular branching, infiltrating deep into stroma

Question 34

Does invasion occur first in the pelvic soft tissues or the muscle of the bladder or rectum?

Answer 34

pelvic soft tissues

Question 35

What stage is confined to the cervix? 5 year survival?

Answer 35

I 80-93%

surgery or radiation

Question 36

What stage extends beyond the cervix but not to the pelvic sidewall or lower third of vagina? 5 year survival?

Answer 36

II 60%

radiation

Question 37

What stage extends to pelvic sidewall and/or lower third of the vagina? 5 year survival?

Answer 37

III 34%

radiation

Question 38

What stage involves extension beyond the true pelvis and may involve bladder or the rectum? 5 year survival?

Answer 38

IV 15%

radiation