Lecture 69 - pathology of cervical cancers

Question 1

High risk HPV

Low Risk HPV

Answer 1

High: 16, 18, 31, 33

Low: 6, 11

Question 2

______-age women are more susceptible to HPV infections

______% of HPV infections persist longer than 2 years

Answer 2

younger women – higher prevelance of HPV infection,

10%

Question 3

what is HPV protein is used to generate the HPV vaccine?

What HPV proteins are oncogenic ? respected tumor suppressors which are suppressed?

what cellular marker can help determine if there is an HPV integrated infection?

Answer 3

L1 gene – used to generate the vaccine

E6 - blocks p53
E7 - blocks Rb

P16 = downregulared by Rb; therefore upregualted in HPV integrated infection

Question 4

Hierarchy of pap smear cytological findings according the bethesda critera;

what if the findings are kind of ambiguous

Answer 4

LSIL – low grade squamous intraepithelial lesion

HSIL – high grade

ASCUS – atypical squamous cells of undeteremined significance

ASCH – Atypical squamous; cannot exclude HSIL

Question 5

ASCUS is suggestive for ___

ASC H is suggestive for___

appropriate management for each

Answer 5

ASCUS - LSIL suggestive changes;
Managed: HPV testing; If postive proceed with colposcopy and bx

ASC H – HSIL suggestive;
Managed: Colposcopy and bx

Question 6

LSIL –

likely progression?
what are the cellular changes due to ?

____%positive for high risk HPV

Management:

Answer 6

10% progress to HSIL

cell changes: Productive HPV infection, but this is very likely to regress

80% positive for high risk HPV

Management: Pap testing; colposcopy + biopsy

Question 7

HSIL

____% progress to SCC

Cell changes due to ____

____% postiive to high risk HPV

management:

Answer 7

10% progress to SCC

Cellular change due to Integrated HPV virus

100% positive for high risk HPV

management:
Colposcopy, Bx
LEEP vs Cold Knife Cone

Question 8

Most common type of cervical cancer

Answer 8

SCC

Question 9

Additional Type of cervical cancer

associated with what form of HPV

what is the screening method for this type of cancer?

Answer 9

Cervical Adenocarcinoma

HPV 18

Prognosis is worse than SCC

No screening. Pap is not sensitive enough

Question 10

current recommendations for Pap smears

when do you stop testing?

Answer 10

Age 21 and over – every three years

Women 30+ – every 3 years, or every 5 years if HPV DNA co -testing negative

Stop testing: 65 yo with adquanate prior negative testing