Neoplasms - Cervical CA and Endometrial CA Flashcards
Cervical carcinoma is a common cancer associated with
human papillomavirus (HPV), a sexually transmitted infection
RF cervical CA
tobacco use, HIV, and infection with high-risk HPV types
sexual activity, multiple sexual partners, smoking, low Vitamin A and C, and history of a sexually transmitted infection
high risk HPV types
16, 18, 31, 33, 45, 52, 58
Patients who have an abnormal Pap smear or high-risk HPV types should undergo
colposcopy, a diagnostic procedure in which a dissecting microscope called a colposcope is inserted into the vagina, allowing the clinician to examine the vagina and the transformation zone of the cervix
During a colposcopy, acetic acid or Lugol solution may be applied to the cervix to detect for the presence of abnormal areas that need to be biopsied
The transformation zone is located
between the squamous epithelium and columnar epithelium of the cervix and is an area of active squamous metaplasia
Most cervical carcinomas occur
in the transformation zone
MC type of cervical CA
squamous cell CA
definitive tx cervical CA
total hysterectomy with a bilateral salpingo-oophorectomy
when is Loop electrosurgical excision an appropriate therapy in cervical CA
In whom there is no endocervical involvement and invasive cervical carcinoma has been ruled out
cervical CA sx
most asx
sx - abnormal vaginal bleeding, postcoital bleeding
practice chart question 6 neoplasms
you got this
what should pts avoid 24H before colposcopy
patients should be instructed to avoid douching, tampon use, vaginal medications, and sexual intercourse for 24 hours prior to a colposcopy
third most common gynecological cancer
cervical CA
average age dx cervical CA
45
American Cancer Society and the United States Preventative Services Task Force screening guidelines for cervical CA
Pap smear alone should be done every 3 years for those between the ages of 21 to 29, followed by co-testing with a Pap smear along with HPV testing every 5 years for all women between the ages of 30 and 65
the diagnosis method of choice for cervical cancer
colposcopy with biopsy
What form of cervical cancer is linked closely to diethylstilbestrol exposure?
Clear cell adenocarcinoma
how long can cervical CA take to develop
up to 15 years to develop after an initial HPV infection
btwn adenocarcinoma and squamous cell carcinoma cervical CA, which has a worse prognosis
adenocarcinoma
True or false: cigarette smoking is associated with an increased risk of squamous cell carcinoma of the cervix but not of adenocarcinoma
true
Abnormal findings on Pap smear include
squamous cells of unknown significance (ASC-US), low-grade or high-grade squamous intraepithelial lesion (LSIL or HSIL), cervical intraepithelial neoplasia III, carcinoma in situ, and invasive cancer
Women with ASC-US and a negative HPV screening should follow-up in
1 year with repeat Pap smear and HPV testing
colposcopy should be performed on patients with
positive HPV test with ASC-US, HSIL, LSIL, or atypical glandular cells
Abnormal changes in colposcopy
white patches and vascular atypia
if abnormal changes are seen on colposcopy
punch biopsy or endocervical curettage should be obtained for further tissue evaluation
he loop electrosurgical excision procedure (LEEP) is used for
HSIL lesions and those lesions that are completely visible without magnification
Conization
surgically removes the entire transformation zone and endocervical canal. It is reserved for severe dysplasia or carcinoma in situ, especially with endocervical extension
practice chart for question 19
you got this
Which complication of loop electrosurgical excision procedure is characterized by recurrent second-trimester miscarriage?
cervical insufficiency
memorize chart for question 21
HAH same as 19 - do it tho
memorize chart for question 26
YOU GOT IT LAST ONE
True or false: endocervical curettage cannot be performed in pregnant women
true
second most common cancer of the female genital tract
endometrial CA
MC type of endometrial CA
adenocarcinoma of the endometrium
who is MC affected by endometrial CA
Postmenopausal women between 50–70 years of age
RF endometrial CA
obesity, nulliparity, diabetes, polycystic ovarian syndrome (or any other condition characterized by prolonged anovulation due to unopposed estrogen), prolonged unopposed estrogen therapy, and long-term use of tamoxifen
hypertension, Lynch syndrome, and endometrial hyperplasia
sx endometrial CA
abnormal uterine bleeding without any other symptoms. Pain is a late finding.
women who are pre- or perimenopausal may present with menorrhagia or metrorrhagia
dx endometrial CA
endocervical and endometrial sampling. A Papanicolaou smear of the cervix may reveal some abnormal endometrial cells, but this is not a sensitive test. A hysteroscopy or hysteroscopically directed biopsy is helpful in visualizing any growths or lesions within the uterine cavity. A vaginal ultrasonography also helps in the diagnosis of this condition by measuring the thickness of the endometrium, also known as the endometrial stripe
TVUS endometrial CA postmenopausal women
if the endometrium appears hypertrophic, it may indicate a neoplastic change.
An endometrial stripe measurement of 4 mm or less indicates a low likelihood of hyperplasia or endometrial cancer in postmenopasual women. If it is greater than 4 mm or if certain areas of the endometrium appear heterogeneous, there should be a high index of suspicion and an endometrial sample should be obtained
TVUS - what can exclude endometrial CA in premenopausal women
an endometrial thickness of < 5 mm can exclude endometrial carcinoma
All postmenopausal women with abnormal vaginal bleeding should undergo
endometrial sampling
tx endometrial CA
total hysterectomy and bilateral salpingo-oophorectomy. If the cancer has invaded into the myometrium or if the lymph nodes are affected, a combination of radiation with or without chemotherapy (or vice versa) should be initiated postsurgically.
What other factors may cause a thickened endometrial stripe?
he presence of endometrial polyps, obesity, diabetes, and current tamoxifen therapy
most common cause of gynecologic malignancy in the United States and the fourth most common cause of malignancy in women
endometrial CA
For postmenopausal women with abnormal uterine bleeding, what is the most appropriate initial diagnostic test
TVUS
what may be necessary if the transvaginal ultrasound and endometrial biopsy are inconclusive for suspicion of endometrial CA
Hysteroscopy and dilation and curettage
Patients with endometrial hyperplasia without atypia who desire fertility may be treated with
progestin, either with oral tablets or with a levonorgestrel-releasing intrauterine system
Patients with endometrial hyperplasia with cellular atypia should undergo
hysterectomy plus or minus bilateral salpingo-oophorectomy
What is the most common cause of anovulatory abnormal uterine bleeding in a premenopausal woman?
PCOS
The findings on cervical cytology that suggest possible endometrial cancer
endometrial cells, atypical glandular cells, and adenocarcinoma
