Gynecologic malignancy - cervical cancer

Question 1

what co-factors are important in cervical cancer disease development

Answer 1

• smoking

- immunocompromise

Question 2

Liquid based cytology is used because

Answer 2

• lower false negative rate
• increased sensitivity
• less interference by blood/mucous cells

Question 3

False negative rate in cervical cytology screening

Answer 3

10- 50% false negatives

Question 4

when do you start/stop screening for cervical ca

Answer 4

at age 21

- stop age 65-70 or post hysterectomy with normal pap Hx

Question 5

Cervical cytology screening is NOT

Answer 5

Diagnostic

Question 6

When can you repeat a cervical screen

Answer 6

after 3 months

Question 7

Who gets sent for colposcopy based on screen?

Answer 7

Everyone except ASC, and ASC-US

Question 8

cervical epithelial cells can be

Answer 8

Squamous or glandular

Question 9

what are some alternative causes for abnormal cervical cytology?

Answer 9

infection/inflammation

• cancer other genital source
• regeneration after injury
• post menopausal/postpartum

Question 10

Results for which type of lesions are more predictive in cytopath for cervix?

Answer 10

• Squamous lesions

- glandular lesions harder -

Question 11

what is a koliocyte?

Answer 11

HPV infected cell -

enlarged,irregular, dark, bi-nucleus with a halo

Question 12

A koliocyte is diagnostic for

Answer 12

low grade lesion

Question 13

classical cytology of glandular lesions

Answer 13

Loss of honeycomb apperance,

- adenocarcinoma in situ,

Question 14

how do you treat cervical dysplasia

Answer 14

• cone biopsy, or LEEP

- or ablate if you can see the entire lesion

Question 15

warning symptoms for cervical cancer

Answer 15

• abnormal pap
• post-coital bleeding
• mentometrorrhagia
• post menopausal bleed
• pelvic pain
• vag discharge
• FLANK pain, sciatica, lower limb edema

Question 16

Why can there be flank pain, sciatica and lower limb edema in cervical cancer

Answer 16

• pressing on ureter
• femoral nerves
• and femoral vein

Question 17

diagnostic test for cervical lesion detection

Answer 17

BIOPSY!! cervical biopsy - or through colposcopy

Question 18

cervical cancer is staged

Answer 18

CLINICALLY not surgically -

Question 19

tests that may affect treatment decisions, but do NOT change stage

Answer 19

CT , MRI lymphangiography, PET scan, laproscopy

Question 20

the best role for HPV testing is for which type of lesions?

Answer 20

ASC-US

Question 21

what is the diagnostic evaluation of cervix include

Answer 21

Colposcopy!

Question 22

If lesion is >4cm or have advanced disease what is the clinical management?

Answer 22

• chemoradiation

Question 23

Is disease is in early stage

Answer 23

• radical hysterectomy + pelvic nodes OR

- Chemoradiation -

Question 24

2 most common HPV-induced cervical cancers by histopathology

Answer 24

1) squamous cell carcinoma

2) endocervical adenocarcinoma

Question 25

If tumor is confined to cervix - outcome is

Answer 25

favorable - cured with Sx and Radiation

-

Question 26

If tumor is advanced stage

Answer 26

• no surgery

- chemo radiation/palliation

Question 27

what is highly prognostic in cervical cancer

Answer 27

lymph node involvement

Question 28

Toxicity of therapy for cervical cancer

Answer 28

• loss of fertility
• menopause
• impaired sexual function
• bowel/bladder toxicity