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Women's Health Rotation > Neoplasms > Flashcards

Neoplasms Flashcards

1
Q

Cervical Intraepithelial Neoplasia (CIN)

A

The abnormal growth of potentially precancerous cells in the cervix. Most cases remain stable or are eliminated by the host’s immune system without intervention

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2
Q

Atypical squamous cells

A

Nuclear atypia is present but is not sufficient to warrant the dx of squamous intraepithelial lesion

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3
Q

ASC-US

A

Atypical squamous cells of undetermined significance

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4
Q

ASC-H

A

Cytologic changes suggestive of HSIL, but lacking definitive interpretation
Has a significantly higher predictive value for diagnosing CIN2 or CIN2 than ASC-US Paps

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5
Q

Management of ASC-US Paps

A

Repeat Pap smear until there are 2 consecutive normal Paps
OR
Immediate colposcopy
OR
DNA testing for high-risk types of HPV
Those women with ASC-US Pap smears who test positive for high-risk HPV should undergo colposcopy
Those who test negative should have a Pap in 1 yr
A woman with ASC-US and positive HPV results has the same risk for high-grade dysplasia as if she had an LSIL Pap smear and thus requires colposcopic eval
A woman with ASC-US and negative HPV can be reassured, treated as if she had a nl Pap smear, and followed with a Pap in 1 yr

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6
Q

Atypical glandular cells

A

Atypia that is of glandular rather than squamous origin
More likely to be serious with glandular abnormalities than an ASC-US Pap, so the work up is more aggressive than with an ASC-US Pap
If ID-ed, it will also report endocervical adenocarcinoma and adenocarcinoma in situ

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7
Q

Subdivisions of atypical glandular cells

A

Atypical endocervical
Atypical endometrial
Atypical glandular cells not otherwise specified
It may also say “favors neoplasia”

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8
Q

Atypical glandular cell management

A

All pts with AGC Pap smears should have colposcopy with endocervical sampling with the exception of pts with atypical endometrial cells
In those pts who have an AGC Pap smear with an abnormal bleeding hx, or who are >35 yrs, an endometrial bx should be added to the initial colposcopy and endocervical sampling

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9
Q

Atypical glandular cells, not otherwise specified management

A

If the initial work-up is negative, repeating Paps at 4 to 6-month intervals is indicated until there are 4 consecutive, negative Pap smears

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10
Q

Atypical glandular cells, favors neoplasia management

A

If the initial work up is negative these pts are treated in the same manner as those with adenocarcinoma in situ Pap smears and require a diagnostic excisional procedure

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11
Q

Low-grade Sqamous Intraepithelial Lesions

A

Includes findings of CIN1 (mild dysplasia) and findings consistent with HPV infection

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12
Q

High-grade Squamous Intraepithelial Lesions

A

CIN2 and CIN3 lesions (moderate dysplasia, severe dysplasia, and carcinoma in situ)

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13
Q

LSIL management

A 
Referral for colposcopy
May do "watchful waiting" if under 25 yoa
Endocervical sampling (along with biopsies of any lesions visualized on colposcopy)is considered preferred in pts with unsatisfactory colposcopy or in those with satisfactory colposcopy and no lesion identified.
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14
Q

Where are abnormal biopsy samples from LSIL colposcopy sent?

A

Pathologist determines if there is any evidence of precancerous changes, called cervical intraepithelial neoplasia
These changes are categorized as being mild (CIN1) or moderate to severe (CIN 2 or 3)

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15
Q

Management of LSIL biopsy that confirms CIN1

A

If the lesion does not extend into the endocervical canal, pts can be followed with serial Pap smears with or without colposcopy for up to 24 mos before tx is necessary

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16
Q

What if LSIL bx confirms CIN1 and the lesion extends into the cavity?

A

An excisional procedure is recommended

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17
Q

HSIL management

A

All women should receive colposcopy with bx of any abnl areas along with endocervical sampling
Excisional procedures are recommended if the entire cervix is not able to be visualized during the colposcopy if over 24 yoa

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18
Q

When should excisional procedures be performed with HSIL?

A

If the cervix, during colposcopy, appears clearly abnormal, with follow up done based on pathology report

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19
Q

Types of cervical CA

A 
Squamous cell carcinoma
-About 80-85%
Adenocarcinoma
Adenosquamous carcinoma
Neuroendocrine carcinoma
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20
Q

RFs for cervical CA

A

HPV infection
Smoking
HIV infection
Chlamydia infection
Dietary factors (diets low in fruits and veggies)
Hormonal contraception
Multiple pregnancies
Age less than 17 with first full-term pregnancy
Exposure to the drug diethylstilbestrol (DES)
FHx of cervical CA

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21
Q

Stage 0 cervical CA

A

Full thickness involvement of the epithelium without invasion into the stroma (carcinoma in situ)

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22
Q

Stage IA cervical CA

A

Dx-ed only by microscopy, no visible lesions
IA1- stromal invasion <3 mm in depth and 7 mm or less in horizontal spread
IA2- stromal invasion between 3 and 5 mm with horizontal spread of 7 mm or less

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23
Q

Stage IB cervical CA

A

Visible lesion or a microscopic lesion with more than 5 mm of depth or horizontal spread of more than 7 mm, no spread to nodes or other organisms
IB1- visible lesion less than 4 cm greatest dimension
IB2- visible lesion more than 4 cm

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24
Q

Stage IIA cervical CA

A

Without parametrial invasion, but may involve upper 2/3 of vagina
IIA1- visible and less than 4 cm, no node involvement, no distant sites
IIA2- visible and greater than 4 cm, no node involvement, no distant sites

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25
Q

Stage IIB cervical CA

A

With parametrial invasion, no node involvement

26
Q

Stage I cervical CA

A

Limited to the cervix, no spread to nodes

27
Q

Stage II cervical CA

A

Invades beyond cervix

28
Q

Stage III cervical CA

A

The CA has spread to the lower part of the vagina or the walls of the pelvis. The CA may be blocking the ureters. It has not spread to nearby LNs or distant sites

29
Q

Stage IIIA cervical CA

A

The CA has spread to the lower third of the vagina but not to the walls of the pelvis. It has not spread to nearby LNs or distant sites

30
Q

Stage IIIB cervical CA

A

Either:
The CA has grown into the walls of the pelvis and/or has blocked one or both ureters, but has not spread to LNs or distant sites
OR
The CA has spread to LNs in the pelvis but not to distant sites. The tumor can be any size and may have spread to the lower part of the vagina or walls of the pelvis

31
Q

Stage IVA cervical CA

A

Invades mucosa of bladder or rectum and/or extends beyond true pelvis, no nearby nodes are involved, no distant organs or involved

32
Q

Stage IVB cervical CA

A

Distant metastasis, such as lung or liver

33
Q

Tx of stage IA cervical CA

A

Usually treated by hysterectomy, or if she desires to maintain fertility, by cone bx, providing margins are clear

34
Q

Tx of stage IA2 cervical CA

A

Same as stage IA, but LNs are removed as well

35
Q

What may also be performed on women with early cervical CAs (smaller than 2 cm) who desire to preserve their fertility?

A

Radical trachelectomy
The cervix, 2 cm of the upper vagina, and the pelvic nodes are removed with a cerclage placed in the lower uterine segment

36
Q

Tx of stages IB1 and IIA of cervical CA

A

Radical hysterectomy with removal of the LNs or external beam radiotherapy
to the pelvis and brachytherapy (internal radiation)
May be given with or without chemo in order to reduce the risk of relapse

37
Q

Tx of stages IB2 and IIA of cervical CA

A

Radiation therapy and cisplatin-based chemo, hysterectomy (which then usually requires adjuvant radiation therapy) or cisplatin chemo followed by hysterectomy

38
Q

Tx of IIB-IVA cervical CA

A

Radiation and cisplatin-based chemo

39
Q

Cervical CA follow-up

A

Includes detailed H&P, particularly abdominal complaints and LN assessment
Cervical CA can recur in 15-61% of cases in the first 2 yrs

40
Q

Complaints worrisome for the recurrence of cervical CA

A 
Vaginal bleed or d/c
Bleeding after intercourse
Abdominal or pelvic pain
Urinary sx
Change in bowel habits
41
Q

Worrisome PE findings for the recurrence of cervical CA

A

Enlarged LNs (in particular groin or supraclavicular)
Vaginal lesions that are friable, raised or nodular
Nodularity in the rectovaginal septum
Palpable mass at any location, particularly the pelvis

42
Q

Locations of vulvar CA

A

Most often affects labia, but may start on the clitoris or in glands on the sides of the vaginal opening

43
Q

Type of vulvar CA

A 
Majority of vulvar CAs are of squamous origin
Other possibilities:
Melanoma
Adenocarcinoma
Sarcoma
Basal cell carcinoma
44
Q

When in life does vulvar CA usually occur?

A

After menopause, in women age 50 or older

However, numbers in younger women are climbing

45
Q

RFs of vulvar CA

A

Previous HPV infection

Previous cervical or vaginal CA, or syphilis infection

46
Q

Who has a greater risk of developing vulvar CA that metastasizes?

A

Women with a condition called vulvar intraepithelial neoplasia

47
Q

Vulvar CA sx

A 
Ulcer, thickening, or lump
-Usually on the labia majora
-May be anywhere on the vulva
Local itching, pain, burning, bleeding
Pain with urination
Pain with intercourse
Unusual odor
Nearly 20% with vulvar CA have no sx
48
Q

Dx of vulvar CA

A

Pelvic exam to look for any skin changes
Excision and bx of the lesion to make an accurate dx
80% cure rate

49
Q

Appearance of squamous vulvar carcinoma and adenocarcinoma

A

Usually appear as a growth on the surface of the vagina
Squamous carcinoma may present as an open sore (ulcer)
Adenocarcinoma may lie deeper so that it is not visible and detected only by palpation

50
Q

Appearance of vaginal melanoma

A

Brown or black skin tag (polypoid), growth attached to the vaginal wall by a stem (pedunculated), nipple-like growth (papillary), or fungus like growth (fungating)

51
Q

Appearance of sarcoma- vulvar CA

A

Grape-like mass

52
Q

Tx of vulvar CA

A

Surgery to remove the CA cells. If the tumor is large (>2 cm) or has grown deeply into the underlying skin, the LNs in the groin area may also be removed
Radiation, with or without chemo, may be used to treat advanced tumors or vulvar CA that comes back

53
Q

Stage 0 vulvar CA

A

Carcinoma in situ

Intraepithelial neoplasia grade III

54
Q

Stage I vulvar CA

A

Lesion <2 cm
Confined to the vulva or perineum
No nodal metastasis

55
Q

Stage Ia vulvar CA

A

Lesion <2 cm

Confined to the vulva or perineum and with stroma invasion 1 mm; no nodal metastasis

56
Q

Stage Ib vulvar CA

A

Lesion <2 cm
Confined to the vulva or perineum and with stromal invasion >1 mm
No nodal metastasis

57
Q

Stage II vulvar CA

A

> 2 cm in greatest dimension
Confined to the vulva and/or perineum
No nodal metastasis

58
Q

Stage III vulvar CA

A

Tumor of any size with adjacent spread to the lower urethra and/or vagina or anus and/or unilateral regional LN metastasis

59
Q

Stage IVa vulvar CA

A 
Tumor invasion of any of the following: 
Upper urethra
Bladder mucosa
Rectal mucosa
and/or pelvic bone and/or bilateral regional node metastases
60
Q

Stage IVb vulvar CA

A

Any distant metastasis, including pelvic LNs

Women's Health Rotation (15 decks)

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