Female Genital 1 Flashcards
What is necessary for the development of most cervical cancer?
HPV- high risk HPVs are the single most important factor in cervical oncogenesis
What are the two most high risk HPV types?
16 and 18
31,33,45,51
Viral proteins E6 and E7 inactivate what?
p53 and Rb respectively
In most cases the viral DNA is maintained separately from the host DNA as an episome, but what happens in cases of malignant transformation?
viral DNA is integrated into the host genome
What percent of HPV infections are transient?
90%
- not detectable within a few years
- women whose infections persist are at greatest risk of developing cervical lesions
What percentage of men and women will be infected with HPV at some time?
80%
Is HPV 16 or 18 more common in cervical cancer cases?
16
Besides HPV, what are 4 other additional risk factors to cervical carcinoma?
smoking
diet
combined oral contraceptives
immunosuppression
T-F cervical cancer is the #1 cause of cancer death in women in the US?
False- 14th it was number 1 in 1950
What 2 ways does screening reduce deaths?
- increasing the detection of invasive cancer at early stages
- increasing the detection of pre invasive lesions
age 21-29 women need what PAP protocol? 30-65? >65?
- pap every 3 yrs
- pap and HPV co test every 5 years or pap every 3 years
- no testing if adequate prior negative testing
Where do most cervical carcinomas arise?
at or near the squamocolumnar junction
What is a key benefit of the liquid-based pap test? do they have a lower or higher false negative/positive rate?
can also perform HPV testing on the residual sample
can make multiple slides too
LOWER FALSE NEGATIVE RATE BUT A HIGHER FALSE POSITIVE RATE
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?
- increases sensitivity
- cervical squamous carcinoma
- yes
- adenocarcinomas or any other types of cancers in that area
What type of cell does HPV infect? where are they most accessible?
- basal cells
2. ssquamocolumnar junction
How do we obtain a histological biopsy of cervix?
colposcopy
What are we looking for in a pap test?
nuclear changes that are surrogate marker for the presence of HPV
CINI represents how thick the basal layer ascends? CINII? CINIII?
- lower third
- middle third
- upper third/full thickness (severe dysplasia vs. CIS)
What are the 4 key diagnosis made from pap tests?
- NILM (negative for intraepithelial lesion or malignancy)
- ASCUS- (atypical squamous cells of undetermined significance)
- LSIL
- HSIL
Where do ASCUS cells fall into the diagram of histological classifications?
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
What are the hallmark of low-grade SIL? describe them?
Koilocytes- which are squamous cells with enlarged nuclei, low N:C ratio, crisp perinuclear clearing (indicative of presence of HPV)
What do we see in colposcopy of high grade SIL (HSIL)/CINII
More dense acetowhite areas and punctations due to abnormal blood vessels. GETS WORSE AND MORE EXTENSIVE FOR WORSE LESIONS
Do we still see koliocytes in CIN3?
No
In pap of HSIL, are single cells often present?
Yes…unlike LSIL and lesser grade lesions
What is the management of women with HSIL?
immediate loop electrosurgical excision or colposcopy with assessment
What is the goal of excisional procedures like the LEEP or cold knife?
remove all HPV related lesions with clear margins
What is the most common type of cervical carcinoma?
squamous cell 75%
adenocarcinoma 15%
What are the strict requirements for micro invasive carcinoma?
less than 3mm depth and 7mm horizontal extent
Most patients with carcinoma of cervix have what symptom? what other symptoms are common?
- NONE!
2. post-coital bleeding, vaginal bleeding, vaginal discharge
What is a strong sign of invasive squamous cell carcinoma?
desmoplasia
What is difficult about cervical adenocarcinoma?
more difficult to sample on pap and also more difficult to interpret for pathologist
What do we see histologically in cervical adenocarcinoma in situ?
glands with pseudo stratified hyper chromatic nuclei with apoptoses and mitoses
What do we see histologically in invasive cervical adenocarcinoma
malignant haphazard glands with irregular branching, infiltrating deep into stroma
Does invasion occur first in the pelvic soft tissues or the muscle of the bladder or rectum?
pelvic soft tissues
What stage is confined to the cervix? 5 year survival?
I 80-93%
surgery or radiation
What stage extends beyond the cervix but not to the pelvic sidewall or lower third of vagina? 5 year survival?
II 60%
radiation
What stage extends to pelvic sidewall and/or lower third of the vagina? 5 year survival?
III 34%
radiation
What stage involves extension beyond the true pelvis and may involve bladder or the rectum? 5 year survival?
IV 15%
radiation
