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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
When the diagnosis is absolutely clear.... How is cervical intraepithelial neoplasi managed?
Destructive therapies.... Cryotherapy LEEP Cold Knife Conization
26
In regards to cervical cancer, there is a(n) ________ (increasing/decreasing) prevalence.
Decreasing Prevalence
27
What is the mean age for cervical cancer diagnosis?
48 Years
28
What are examples of risk factors for cervical cancer?
``` HPV Infection Young age at first coitus Smoking Multiple Partners Low socioeconomic status Underdeveloped countries ```
29
What are Sx of cervical cancer?
``` Post-coital spotting Vaginal discharge vaginal bleeding Pelvic pain radiating to the leg Dysuria Hematuria Rectal Bleeding ```
30
How may the cervix appear on pelvic examination in a patient with cervical cancer?
Friable, Exophytic Mass Necrotic Ulcerations Barrel Shape Appearance
31
How is cervical cancer diagnosed?
Biopsy
32
What is the most common form of cervical cancer? A) Adenocarcinoma B) Small Cell Carcinoma C) Squamous Cell D) Lymphoma
C) Squamous Cell - (80 - 90%)
33
What type of surgical procedure can be done for cervical cancer treatment to preserve fertility with small volume tumors?
Tracelectomy
34
How are early cervical cancer lesions managed typically? Advanced lessions?
Early: Surgery (Hysterectomy + Radiation) Advanced: Radiation + Chemotherapy (Cisplatin, 5-FU)
35
What is the name of the device used in intracavitary radiation?
Fletcher Applicator
36
Which of the following types of cervical cancer has the highest 5-year survival rate? A) Localized B) Distant C) Regional
A) Localized - (91%)
37
What is the most frequent GYN cancer seen in the unites states? Is the incidence of this cancer increasing or decreasing?
Endometrial Cancer The incidence of endometrial cancer is actually increasing
38
What is the median age of diagnosis for endometrial cancer?
61 years old
39
What is the biggest risk factor for developing endometrial cancer?
Unopposed Estrogen
40
T/F: Women who have never been pregnant have a lower risk of endometrial cancer
False They have a higher risk
41
What breast cancer medicine increases the risk of endometrial cancer?
Tamoxifen
42
What 'hereditary factor' is associated with endometrial cancer?
Lynch II Syndrome
43
What are THREE preventative measures taken to prevent endometrial cancer?
Oral Contraceptives Avoiding estrogen only therapy Avoid obesity
44
______ (Type I/Type II) endometrial cancer in hormone dependent, while _____ (Type I/Type II) endometrial cancer does not have hormonal involvement
Type I - Hormonal Type II - No hormonal
45
Does type I or type II endometrial cancer have a good prognosis?
Type 1 - Good Prognosis Type II - Poor Prognosis
46
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) Adenocarcinoma
47
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 ```
B) Adenoacanthoma
48
The following are all symptoms of ________ cancer..... Post-menopausal bleeding Brownish discharge Irregular bleeding
Endometrial Cancer
49
How is endometrial cancer diagnosed?
Biopsy US Hysteroscopy D&C
50
How is endometrial cancer managed?
Radiation (Vaginal + External) Chemotherapy Progestational Agents
51
Why would a pelvic lymphadenectomy be done when treating endometrial cancer? What are unique 'side effects' to this surgery?
Detect nodal metastasis and plan personal treatment plan Side Effects: Lymphedema, Lymphocysts
52
Which of the following in the most common form uterine sarcoma? A) Leiomyosarcoma B) Endometrial stromal sarcoma C) Mixed mesodermal sarcoma
B) Endometrial stromal sarcoma - (44%)
53
T/F: Uterine sarcoma is more prevalent in Caucasian women
False It is more prevalent in African American women
54
Uterine sarcomas have a high risk of distant _______.
Metastasis
55
Uterine sarcomas have a _____ (high/low) response to therapy
Low response
56
T/F: Even stage 1 uterine sarcoma only has a 50% survival rate
True
57
Low grade malignancy epithelial tumors are ____ (well/poorly)-differentiated
Well-Differentiated
58
High grade malignancy epithelial tumors are ____ (well/poorly)-differentiated
Poorly-Differentiated
59
What is the most common site for fallopian tube cancer to originate?
Fimbriae
60
T/F: Fallopian tube cancer is clinically similar to Ovarian Cancer
True
61
Adenocarcinoma of the peritoneum typically originates from what condition?
Endometriosis
62
___% of death from GYN cancers come from ovarian cancers
47%
63
T/F: Low SES is a risk factor for ovarian cancer
False Actually higher SES is considered a risk factor
64
What are risk factors associated with ovarian cancer?
``` Family history Frequent ovulation Low parity Caucasian High fat, low fiber diet Talk exposure Living in northern countries ```
65
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.
Decrease risk of ovarian cancer Increased risk of breast cancer
66
Which BRCA mutation has the highest risk for ovarian cancer?
BRCA 1 (40-46%)
67
Should you screen for ovarian cancer? What would qualify for screening?
Not recommended due to low prevalence Screen: Family Hx @ 30-35 y.o with Exam, CA 125, US Hereditary @ 25 with above
68
The following Sx/"red flags" are associated with ______ cancer.... Strange GI Complaints Early Satiety Abdominal Distension/Bloating Persistent Pelvic Pain (Postmenopausal Women)
Ovarian
69
Which lab values are helpful in diagnosing ovarian cancer?
CA 125 OVA 1 CEA
70
What THREE imaging studies are useful in diagnosing ovarian cancer?
Pelvic US CT Abdomen/Pelvis CXR
71
Of all components involved in working up a possible ovarian cancer..... Which THREE are most sensitive/specific for the diagnosis?
CA 125 Pelvis Ultrasound Menopausal Status
72
Sertoli-Leydig cell ovarian tumors are ______ (epithelial/stromal) with a _____ (high/low) malignancy profile
Stromal Low Malignancy Profile
73
What is the most common management of ovarian cancer?
Surgery (many kinds) Followed by systemic or intra-peritoneal chemotherapy post-op
74
Cervical cancer is the ______ most common cancer world wide. A) First B) Second C) Third D) Fourth
D) Fourth
75
What is the goal of cervical cancer screening?
Prevention of morbidity and mortality from the disease
76
T/F: The goal of cervical cancer screening is to detect HPV
False
77
T/F: HPV is considered a STI
True
78
Other than cervical cancer..... What cancers is HPV associated with?
Anal Cancer Rectal Cancer Throat Cancer
79
Where in the female genitalia does HPV love to 'live'?
Transition Zone where columnar and squamous cells meet
80
T/F: A persistent HPV infection for longer than 5 years lowers a patients risk of cervical cancer
False This is considered 'the key' to getting cancer
81
When should each of these patient groups receive a PAP smear? < 21: 21 - 29: > 30: >65:
<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
What does ASC-US stand for?
Atypical Squamous Cells
83
What does LSIL stand for?
Low grade squamous intraepithelial lesion
84
What does ASC-H stand for?
ASC-US but can NOT r/o high grade lesion
85
What does HGSIL stand for?
High-grade squamous intraepithelial lesion
86
What does AGUS stand for?
Atypical Glandular Cells
87
What does CIS stand for?
Carcinoma Insitu
88
If a PAP is considered 'unsatisfactory' when should a repeat be completed?
In 2-4 month
89
If a PAP and HPV test are done at the same time and the HPV is positive..... When should repeat testing be done?
2 - 4 months
90
If genotyping reveal HPV 16, 18..... What follow up test should be done?
Colposcopy
91
If you have 'unsatisfactory' PAP smears 2x in a row..... What procedure should be done?
Colposcopy
92
Women ages 21-24 have a ____ (low/high) risk for invasive cervical cancer but a ____ (high/low) risk for HPV exposure and associated lesion
Low-risk for invasive cervical cancer High-risk for HPV
93
Of the following, which is most likely to require treatment..... A) CIN III B) CIN I C) CN II
A) CIN III The other two, observation is the preferred management option
94
What should the follow up treatment of the following PAP results be..... ASCUS & HPV -
Repeat testing in 1-3 years
95
What should the follow up treatment of the following PAP results be..... ASCUS & HPV +
Repeat in q year with HPV typing OR Colposcopy
96
What should the follow up treatment of the following be..... LGSIL
Colposcopy
97
What should the follow up treatment of the following be..... HGSIL
Colposcopy
98
What should the follow up treatment of the following be..... ASCUS-H
Colposcopy
99
How is CIS treated?
Ablation regardless of age

Reproductive Medicine Exam 3 (10 decks)

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