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O&G > preinvasive and early invasive cervical lesions > Flashcards

preinvasive and early invasive cervical lesions Flashcards

1
Q

what is the normal cervix anatomy

A

4cm in length (pinky size)

external cervical os is 1 cm in diameter

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2
Q

origin of pap smear

A

dr papanikolau did smears of his wife’s cervix every day and compared it to other women with cervical cancer

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3
Q

epidemiology of cervical cancer

A

incidence has increased d/2 general increase in promiscuity

mortality has reduced d/2 early dg from pap smears

3rd most common cancer in women after ovarian and endometrial

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4
Q

why is the hpv vacc (Gardasil) given in adolescence

A

optimum response of the vaccine occurs oin adolescent years

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5
Q

when is CIS dg vs when cervical cancer

A

CIS: 25

cervical cancer: 52

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6
Q

how is a sample from the endo cervix taken

A

brush through the opening into the canal

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7
Q

how is a sample from the exocervix taken

A

with a spatula

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8
Q

when is the first pap smear taken

A

21 years of age is the first pap smear

cytology only

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9
Q

how often should pap smears be taken

A

every 3 years after the first if the results are normal

until 30

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10
Q

routine pap smear for ages 30 - 65

A

pap smear every 3 years

if additional hpv testing is done the next pap is in 5 years

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11
Q

routine pap smear for 65y/o

A

discontinued IF

  • never had an abrnormal pap smear
  • rx from CIN 2+ was over 20 years ago
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12
Q

routine paps for hysterectomy pts

A

discontinue paps IF

  • hysterectomy was not done d/2 cancer
  • no abnormal pap in 2o years
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13
Q

which women are advised to continue paps

A

Women w/ RF for cervical cancer e.g.

  • immunocomp/HIV
  • exposure to Diethylstilbestrol in utero
  • chronic steroid use
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14
Q

list the abnormal cytology results from pap smears

(intraepithelial lesions)

A
  1. ASCUS (atypical sq cells of undetermined sig)
  2. LSIL (low grade sq intraepi lesion)
  3. ASCH (atypical sq cells, can’t exclude HSIL)
  4. HSIL ( high grade sq intraepi lesion)
  5. AGC (atypical glandular cells)
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15
Q

what does ASCUS MEAN

A

abnormal cells on cytology but unsure about what they are

  • HPV test is done
  • colposcopy done ONLY IF high risk hpv found
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16
Q

what is LSIL

A

CIN 1

  • hpv testing
  • colposcopy
17
Q

what is ASC-H

A
  • ominous looking cell but HSIL not confirmed

COLPOSCOPY is mandatory

18
Q

what does it mean if you get HSIL

A

CIN2/CIN3 LIKLEY

  • colposcopy mandartory
  • if fertility isn’t wanted then LEEP
19
Q

atypical glandular cells

A

suggests abnormalities in the uterus

20
Q

how to take biopsy during colposcopy

A

apply acetic acid and look for abnormal staining in the transitional zone

  • area’s that stain white
  • cobble stone / mosaic looking areas
  • punctated vessels
  • abnormal vessel geography
    • hair pin loops
    • non tree like
21
Q

how are biopsies taken in during colposcopy

A

Conization

  • Procedure: excision of a cone of cervical tissue that contains parts of both the ectocervix and endocervix
  • performed using a cold knife, electrosurgical loop (LEEP), or a laser
    • Premenopausal: transformation zone biopsy from ectocervix → shallow cone
    • Postmenopausal: transformation zone biosy from endocervix → deep cone
22
Q

side effects of Conization

A
  1. Intraoperative or postoperative bleeding
  2. Cervical stenosis causing infertility
  3. Cervical insufficiency during pregnancy
  4. Infection, uterine perforation
23
Q

why do we need biopsy

A

tells the depth of the lesion

determines the therapeutric action

24
Q

how do dysplastic cells appear

A

Ovoid, eccentric and larger nuclei

25
Q

what is CIN 1

bethseda: LSIL

A
  • Epithelial architecture mostly intact
  • mitotic figures in lower third of the epithelium
  • Koilocytes may be present
26
Q

what is CIN II

  • bethseda
  • LSIL: w/o hpv16
  • HSIL: w/ HPV 16
A
  • Loss of epithelial architecture into as far as the middle third or 2/3of the epithelium
  • Koilocytes may be present.
27
Q

what is CIN III

Bethseda: HSIL

A
  • Complete loss of organized epithelial architecture
  • Irregular nuclei and mitotic figures can be found throughout all epithelial layers.
  • Basal membrane is still intact.

Koilocytes may be present.

28
Q

what is CIS

A

complete loss of all normal architecture

abnormal cells reach up to basement membrane w/o penetration

29
Q

therapeutic steps with CIN1

A

repeat pap + HPV testingin 1 year

(gives body a chance for self resolution)

  1. normal results: routine pap in 3 years
  2. abnormal results for either: repeat colposcopy and biopsy
30
Q

procedures for CINI-III

A

surgical resection w/

  1. leep
  2. cryo
31
Q

what is LEEP

A

loop electrical excision provedure

  • thins the functional cervix
  • different from biopsy as a larger amount of the cervix is removed for rx
  • further biopsy may be done to ensure clear margins
32
Q

natural progression of CIN 1 lesions

A

CIN I

  • 60% Regress spontaneously
  • 30% persist
  • 10% progress to CIN IIi
  • LESS THAN 1% become canceroues
33
Q

natural progression of CIN II lesions

A

40% regress

35% persist

20% CIN III

5% cervical cancer

34
Q

CIN III progression

A

30% regress

50% stay CIN III

12-22% cervical cancer

O&G (43 decks)

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