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PATH310 > HPV 1 > Flashcards

HPV 1 Flashcards

1
Q

4 steps in cervical cancer development (IPPI)

A

infection of metaplastic epithelium at cervical transformation zone, persistence of infection, progression to cervical precancer, invasion thru basement memb below epithel

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2
Q

most women worldwide infected w at least ? HPV types

A

1 or several

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3
Q

do most infections persist

A

most clear in 1-2 yrs & 10% persist, a fraction progress to precancer (depend on HPV type), another invade (20-30% large precancers invade 5 or 10 yrs later)

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4
Q

cervical transformation zone

A

cervical cancer ~arise from ring of mucosa = CTZ. stratified squamous epithel replaces glandular epithel

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5
Q

how are genital HPV infections transmitted

A

mucosa-to-mucosa contact

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6
Q

viral particles reach germinal cells in basal layer how?

A

via tiny tears to mucosa

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7
Q

how many types HPV? what they infect?

A

over 40, infect epithel lining of anogenital tract

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8
Q

how many types HPV assoc w cervical cancer & high risk? probable risk? low risk?

A

15 (cause cancer), 3, 12

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9
Q

2 most carcinogenic HPV types? responsible for 70% cervical cancer & ~50% pre cervical cancer?

A

HPV16 & 18

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10
Q

2 HPV types responsible for ~90% genital warts (NOT pre-cancer)?

A

HPV6 & 11

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11
Q

natural history IRPP

A

infection, resolution, persistence, progression

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12
Q

strongest factor affecting absolute risk of viral persistence, progression

A

HPV type

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13
Q

HPV16 absolute risk of precancer diagnosis

A

HPV16 40% cases progress after 3-5 yrs of persistent infection

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14
Q

lag time bw infection & appearance of 1st microscopic evidence of precancer

A

~within 5 yrs. (histological precancer within as little as 2 yrs)

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15
Q

avg age of precancer diagnosis

A

25-35

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16
Q

human papillomavirus genome encodes only ? genes

A

8

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17
Q

primary HPV oncoproteins? how many cellular targets? most key?

A

E6, E7. numerous targets, esp. p53 & pRB (retinoblastoma tumor suppressor protein)

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18
Q

E6 inhibition of p53

A

block apoptosis

19
Q

E7 inhib of pRB

A

abrogate/escape cell cycle arrest

20
Q

E7 is?

A

primary transforming protein

21
Q

E6 & E7 expressed at ? levels during infection

A

low levels

22
Q

at undefined pt in progression, E6 & E7 expression deregulated by ? what happens?

A

genetic/epigenetic changes. lead to overexpression in full thickness epithel lesion

23
Q

diagnostic classification NLHC

A

normal, LSIL, HSIL, carcinoma (after dysplasia)

24
Q

LSIL

A

low grade squamous intraepithelial lesion. viral infection but not pre-cancer … change shape of halo (clear space around nuclei)

25
Q

HSIL

A

high grade. pre-cancer (progression) … lose halos, little cytoplasm throughout

26
Q

normal squamous mucosa

A

lots nucleus, little cytoplasm, but more cytoplasm, spread on top

27
Q

invasive cancer assoc w

A

integration of HPV genome into host genome = key biomarker distinguish infection from precancer

28
Q

why might integration not be necessary to cause invasion?

A

not all women w invasive cancers have measurable integration

29
Q

risk of cervical cancer ~fxn of

A

HPV infection & lack effective screening (external factors minor compared to high primary risks of most carcinogenic HPV types)

30
Q

what can double risk of pre-cancer, cancer among women infected w carcinogenic HPV

A

smoking, multi-parity, LT use of OCPs

31
Q

cervical cancer prevention

A
  1. screening. pap smear
  2. triage of equivocal results
  3. colposcopy guided biopsy of abnormal results
  4. decide to treat or not
  5. treat / post-treat follow up.
  6. return to normal screening
32
Q

screening - cytology

A

[bethesda system], normal, [ASCUS, LSIL, HSIL], carcinoma

33
Q

ASCUS

A

atypical squamous cells of undetermined significance… equivocal changes (some but criteria to diagnose HPV not met)

34
Q

glass slide

A

smear stain vs wet mount

35
Q

LSIL

A

binucleate or large nucleus, with halo

36
Q

carcinoma

A

huge nucleus, red nucleoli

37
Q

traditional triage

A

normal - repeat every 3 yrs
ascus & lsil - repaet pap in 6 months, refer to colposcopy if still abnormal
hsil/carcinoma - straight to colposcopy

38
Q

colposcopy

A

close up look at cervix.

39
Q

CIN

A

cervical intra-epithelial neoplasia

40
Q

colposcopic biopsy. depend on diagnosis & age of patient, treatment could be ?

A

cryotherapy, LEEP, cold knife cone biopsy

41
Q

loop electrosurgical excision procedure

A

wire w current running thru, slice out tissue, reduce bleeding

42
Q

post treatment follow up

A

colposcopy, pap smear. return to routine screening

43
Q

direct HPV testing

A

screen in ontario, pay $100 to get HPV test along w screening (test neg to reassure/confirm cure post-treatment, indicate who should go to colposcopy & can use post-colposcopy if no pre-cancer found)

PATH310 (8 decks)

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