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Reproductive Medicine Exam 3 > Genital Tract Malignancies / HPV / Cervical Cancer Screening > Flashcards

Genital Tract Malignancies / HPV / Cervical Cancer Screening Flashcards

1
Q

What is the lifetime risk o for contracting HPV in sexually active men and women in the United State?

A

50%

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2
Q

Which two ‘strains’ of HPV are most closely associated with cervical cancer?

A

HPV 16, 18

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3
Q

Which two ‘strains’ of HPV are most closely associated with genital warts?

A

HPV 6, 11

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4
Q

T/F: Being uncircumcised is a risk factor for contracting HPV

A

True

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5
Q

What is the most predominant risk factor for contracting HPV?

A

Sexual Behavior (especially at a younger age)

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6
Q

__% of HPV infections are transient

A

80%

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7
Q

T/F: Persistent HPV infection is a critical risk factor for cervical cancer

A

True

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8
Q

What ages is the HPV vaccine approved for?

A

9 - 26 years old

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9
Q

Cervarix is effective against what HPV strain?

What about Gardasil?

9-Valent?

A

Cervarix: 16, 18

Gardasil: 6, 11, 16, 18

9-Valent: 6,11,16,18, 31, 33, 45, 52, 53

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10
Q

________ _________ ________ is an often asymptomatic white, thickened lesion of the vuvlva which can be concerning in a patient with abnormal pap smears

A

Vulvar Intraepithelial Neoplasia

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11
Q

What is a mandatory part of the work up for vulvar intraepithelial neoplasia?

A

Biopsy

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12
Q

What are three treatment options for vulvar intraepithelial neoplasia?

What is the recurrence rate?

A

Laser Vaporization
Excision
Imiquimod

Recurrence rate is 25 - 50%

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13
Q

______ cancer is common in patients with HPV infections at a younger age as well as a history of granulomatous venereal infections.

Sx include…..

Mass
Puritis
Ulceration
Bleeding
Pain
A

Vulvar Cancer

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14
Q

How is vulvar CA diagnosed?

A

Biopsy

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15
Q

Which of the following is the most common vulvar cancer?

A) Squamous Cell Cancer
B) Melanoma
C) Adenocarcinoma

A

A) Squamous Cell Cancer - 86%

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16
Q

How is vulvar cancer managed early in the disease course?

With advanced lesions?

A

Early: Radical wide excision with 2 cm margins

Advanced: Chemotherapy + Radiation + Radical Excision

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17
Q

What is the screening test for cervical cancer?

A

Pap Smear

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18
Q

HPV Infections have a ______ (high/low) prevalence in young women and a _____ (high/low) prevalence in older women

A

High

Low

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19
Q

T/F: There is a 20% false negative with PAP smear

A

True

Only sample a small amount of cells, biopsy is more definitive

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20
Q

How is cervical intraepithelial neoplasia diagnosed?

A

Pap Smear

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21
Q

______ _________ _______ appears as thick, white lesions on the cervix which appear somewhat consistent with a tissue reaction.

these are asymptomatic

A

Cervical Intraepithelial Neoplasia

High grade dysplasia

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22
Q

What does a ‘mosaicism’ lesion look like?

A

Tiled appearance of thicker, whitish epithelium with surrounding vessel loops

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23
Q

Which TWO of the following would require immediate treatment?

A) HPV Infection in a CIN 1 patient
B) CN II in you patients with good follow-up
C) CN II in you patients with poor follow-up
D) Older patients with CIN II, CN III, or CIS

A

C) CN II in you patients with poor follow-up

D) Older patients with CIN II, CN III, or CIS

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24
Q

How are low-grade dysplasias managed?

A

Observation with regular pap smears

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25
Q

When the diagnosis is absolutely clear….

How is cervical intraepithelial neoplasi managed?

A

Destructive therapies….

Cryotherapy
LEEP
Cold Knife Conization

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26
Q

In regards to cervical cancer, there is a(n) ________ (increasing/decreasing) prevalence.

A

Decreasing Prevalence

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27
Q

What is the mean age for cervical cancer diagnosis?

A

48 Years

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28
Q

What are examples of risk factors for cervical cancer?

A 
HPV Infection
Young age at first coitus
Smoking
Multiple Partners
Low socioeconomic status
Underdeveloped countries
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29
Q

What are Sx of cervical cancer?

A 
Post-coital spotting
Vaginal discharge
vaginal bleeding
Pelvic pain radiating to the leg
Dysuria
Hematuria
Rectal Bleeding
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30
Q

How may the cervix appear on pelvic examination in a patient with cervical cancer?

A

Friable, Exophytic Mass
Necrotic Ulcerations
Barrel Shape Appearance

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31
Q

How is cervical cancer diagnosed?

A

Biopsy

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32
Q

What is the most common form of cervical cancer?

A) Adenocarcinoma
B) Small Cell Carcinoma
C) Squamous Cell
D) Lymphoma

A

C) Squamous Cell - (80 - 90%)

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33
Q

What type of surgical procedure can be done for cervical cancer treatment to preserve fertility with small volume tumors?

A

Tracelectomy

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34
Q

How are early cervical cancer lesions managed typically?

Advanced lessions?

A

Early: Surgery (Hysterectomy + Radiation)

Advanced: Radiation + Chemotherapy (Cisplatin, 5-FU)

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35
Q

What is the name of the device used in intracavitary radiation?

A

Fletcher Applicator

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36
Q

Which of the following types of cervical cancer has the highest 5-year survival rate?

A) Localized
B) Distant
C) Regional

A

A) Localized - (91%)

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37
Q

What is the most frequent GYN cancer seen in the unites states?

Is the incidence of this cancer increasing or decreasing?

A

Endometrial Cancer

The incidence of endometrial cancer is actually increasing

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38
Q

What is the median age of diagnosis for endometrial cancer?

A

61 years old

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39
Q

What is the biggest risk factor for developing endometrial cancer?

A

Unopposed Estrogen

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40
Q

T/F: Women who have never been pregnant have a lower risk of endometrial cancer

A

False

They have a higher risk

41
Q

What breast cancer medicine increases the risk of endometrial cancer?

42
Q

What ‘hereditary factor’ is associated with endometrial cancer?

A

Lynch II Syndrome

43
Q

What are THREE preventative measures taken to prevent endometrial cancer?

A

Oral Contraceptives
Avoiding estrogen only therapy
Avoid obesity

44
Q

______ (Type I/Type II) endometrial cancer in hormone dependent, while _____ (Type I/Type II) endometrial cancer does not have hormonal involvement

A

Type I - Hormonal

Type II - No hormonal

45
Q

Does type I or type II endometrial cancer have a good prognosis?

A

Type 1 - Good Prognosis

Type II - Poor Prognosis

46
Q

Which of the following types of endometrial cancers is the most prevalent?

A) Adenocarcinoma
B) Adenoacanthoma
C) Adeno-squamous carcinoma
D) Clear Cell Carcinoma
E) Papillary Serous Carcinoma
A

A) Adenocarcinoma

47
Q

Which of the following types of endometrial cancers has the highest survival rate?

A) Adenocarcinoma
B) Adenoacanthoma
C) Adeno-squamous carcinoma
D) Clear Cell Carcinoma
E) Papillary Serous Carcinoma
A

B) Adenoacanthoma

48
Q

The following are all symptoms of ________ cancer…..

Post-menopausal bleeding
Brownish discharge
Irregular bleeding

A

Endometrial Cancer

49
Q

How is endometrial cancer diagnosed?

A

Biopsy
US
Hysteroscopy
D&C

50
Q

How is endometrial cancer managed?

A

Radiation (Vaginal + External)
Chemotherapy
Progestational Agents

51
Q

Why would a pelvic lymphadenectomy be done when treating endometrial cancer?

What are unique ‘side effects’ to this surgery?

A

Detect nodal metastasis and plan personal treatment plan

Side Effects: Lymphedema, Lymphocysts

52
Q

Which of the following in the most common form uterine sarcoma?

A) Leiomyosarcoma
B) Endometrial stromal sarcoma
C) Mixed mesodermal sarcoma

A

B) Endometrial stromal sarcoma - (44%)

53
Q

T/F: Uterine sarcoma is more prevalent in Caucasian women

A

False

It is more prevalent in African American women

54
Q

Uterine sarcomas have a high risk of distant _______.

A

Metastasis

55
Q

Uterine sarcomas have a _____ (high/low) response to therapy

A

Low response

56
Q

T/F: Even stage 1 uterine sarcoma only has a 50% survival rate

57
Q

Low grade malignancy epithelial tumors are ____ (well/poorly)-differentiated

A

Well-Differentiated

58
Q

High grade malignancy epithelial tumors are ____ (well/poorly)-differentiated

A

Poorly-Differentiated

59
Q

What is the most common site for fallopian tube cancer to originate?

60
Q

T/F: Fallopian tube cancer is clinically similar to Ovarian Cancer

61
Q

Adenocarcinoma of the peritoneum typically originates from what condition?

A

Endometriosis

62
Q

___% of death from GYN cancers come from ovarian cancers

63
Q

T/F: Low SES is a risk factor for ovarian cancer

A

False

Actually higher SES is considered a risk factor

64
Q

What are risk factors associated with ovarian cancer?

A 
Family history
Frequent ovulation
Low parity
Caucasian
High fat, low fiber diet
Talk exposure
Living in northern countries
65
Q

A patient with a BRCA mutation taking oral contraceptives has a(n) _______ (increased/decreased) risk of ovarian cancer but a(n) _______ (increased/decreased) risk for breast cancer.

A

Decrease risk of ovarian cancer

Increased risk of breast cancer

66
Q

Which BRCA mutation has the highest risk for ovarian cancer?

A

BRCA 1 (40-46%)

67
Q

Should you screen for ovarian cancer?

What would qualify for screening?

A

Not recommended due to low prevalence

Screen:

Family Hx @ 30-35 y.o with Exam, CA 125, US

Hereditary @ 25 with above

68
Q

The following Sx/”red flags” are associated with ______ cancer….

Strange GI Complaints
Early Satiety
Abdominal Distension/Bloating
Persistent Pelvic Pain (Postmenopausal Women)

69
Q

Which lab values are helpful in diagnosing ovarian cancer?

A

CA 125
OVA 1
CEA

70
Q

What THREE imaging studies are useful in diagnosing ovarian cancer?

A

Pelvic US
CT Abdomen/Pelvis
CXR

71
Q

Of all components involved in working up a possible ovarian cancer…..

Which THREE are most sensitive/specific for the diagnosis?

A

CA 125
Pelvis Ultrasound
Menopausal Status

72
Q

Sertoli-Leydig cell ovarian tumors are ______ (epithelial/stromal) with a _____ (high/low) malignancy profile

A

Stromal

Low Malignancy Profile

73
Q

What is the most common management of ovarian cancer?

A

Surgery (many kinds)

Followed by systemic or intra-peritoneal chemotherapy post-op

74
Q

Cervical cancer is the ______ most common cancer world wide.

A) First
B) Second
C) Third
D) Fourth

75
Q

What is the goal of cervical cancer screening?

A

Prevention of morbidity and mortality from the disease

76
Q

T/F: The goal of cervical cancer screening is to detect HPV

77
Q

T/F: HPV is considered a STI

78
Q

Other than cervical cancer…..

What cancers is HPV associated with?

A

Anal Cancer
Rectal Cancer
Throat Cancer

79
Q

Where in the female genitalia does HPV love to ‘live’?

A

Transition Zone where columnar and squamous cells meet

80
Q

T/F: A persistent HPV infection for longer than 5 years lowers a patients risk of cervical cancer

A

False

This is considered ‘the key’ to getting cancer

81
Q

When should each of these patient groups receive a PAP smear?

< 21:

21 - 29:

> 30:

> 65:

A

<21: NoPAP

21-29: Pap every 3 years

> 30: PAP with HPV every 5 years

> 65: No pap is 3 consecutive negative tests, or a negative PAP within the last 10 years

82
Q

What does ASC-US stand for?

A

Atypical Squamous Cells

83
Q

What does LSIL stand for?

A

Low grade squamous intraepithelial lesion

84
Q

What does ASC-H stand for?

A

ASC-US but can NOT r/o high grade lesion

85
Q

What does HGSIL stand for?

A

High-grade squamous intraepithelial lesion

86
Q

What does AGUS stand for?

A

Atypical Glandular Cells

87
Q

What does CIS stand for?

A

Carcinoma Insitu

88
Q

If a PAP is considered ‘unsatisfactory’ when should a repeat be completed?

A

In 2-4 month

89
Q

If a PAP and HPV test are done at the same time and the HPV is positive…..

When should repeat testing be done?

A

2 - 4 months

90
Q

If genotyping reveal HPV 16, 18…..

What follow up test should be done?

A

Colposcopy

91
Q

If you have ‘unsatisfactory’ PAP smears 2x in a row…..

What procedure should be done?

A

Colposcopy

92
Q

Women ages 21-24 have a ____ (low/high) risk for invasive cervical cancer but a ____ (high/low) risk for HPV exposure and associated lesion

A

Low-risk for invasive cervical cancer

High-risk for HPV

93
Q

Of the following, which is most likely to require treatment…..

A) CIN III
B) CIN I
C) CN II

A

A) CIN III

The other two, observation is the preferred management option

94
Q

What should the follow up treatment of the following PAP results be…..

ASCUS & HPV -

A

Repeat testing in 1-3 years

95
Q

What should the follow up treatment of the following PAP results be…..

ASCUS & HPV +

A

Repeat in q year with HPV typing

OR

Colposcopy

96
Q

What should the follow up treatment of the following be…..

LGSIL

A

Colposcopy

97
Q

What should the follow up treatment of the following be…..

HGSIL

A

Colposcopy

98
Q

What should the follow up treatment of the following be…..

ASCUS-H

A

Colposcopy

99
Q

How is CIS treated?

A

Ablation regardless of age

Reproductive Medicine Exam 3 (10 decks)

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