Primary and Secondary Prevention of Cervical Cancers Flashcards
1
Q
Major types of cervical epithelial cells
A
- Ectocervix → Stratified, non keratinizing, squamous epithelium; abundant cytoplasm, dark pyknotic nucleus
- Endocervix → Columnar, mucous secreting, epithelium; may appear in a “honeycomb” array, with distinct cell membranes due to cytoplasmic mucin.
2
Q
cells present?
A
- top of image = mature squamous cells (ectocervix)
- lower left corner = columnar glandular cells (endocervix)
3
Q
HPV virus types/risks
A
- Warts: 6, 11 (low risk)
- Dysplasia:16, 18, others (high risk)
- Carcinoma: 16, 18, others (high risk)
4
Q
Squamous changes in cervical dysplasia
A
- Spectrum of cervical intraepithelial neoplasia (CIN) from left to right:
- Normal squamous epithelium for comparison;
- CIN I with koilocytotic atypia;
- CIN II with progressive atypia in all layers of the epithelium;
- CIN III (carcinoma in situ) with diffuse atypia and loss of maturation.
5
Q
Benign cytology pap smear results and histologic appearance
A
- Normal ==> Normal histology
- ASC = Atypical squamous cells. ASC and more = Colposcopy ==> No direct translation on histo
- ASC-H = Atypical squamous cells cannot exclude HSIL ==> No direct translation on histo
6
Q
Characteristics of LSIL on cytology pap smear results and histologic appearance
A
- LSIL → Low grade squamous intraepithelial lesion
- 50% will be normal
- 40% will be CIN I
- 10% will be CIN II - III
- Usual histo appeareance: CIN I (1.4m)
7
Q
Characteristics of HSIL on cytology pap smear results and histologic appearance
A
- HSIL → High grade squamous intraepithelial lesion
- 30% will be normal
- 30% will be CIN I
- 30% will be CIN II - III
- Usual histo = CIN II* - III* (330k)
8
Q
Most common histologic types of invasive cervical carcinoma
A
- Squamous cell carcinoma - precursor CIN if HPV related
- Cervical adenocarcinoma - precursor is adenocarcinoma in situ (AIS)
9
Q
Gardisil: antigenic components and viral types covered
A
- Antigens
- Quadrivalent L1 virus-like particle (VLP) - yeast
- Viral types
- HPV 6 / 11 / 16 / 18
10
Q
Cervarix: antigenic components and viral types covered
A
- Bivalent virus like particle - yeast
- 16, 18
11
Q
Gardisil: efficacy
A
- Prophylactic efficacy of 98.8% in the reduction of genital warts, CIN 2, CIN 3 and adenocarcinoma in situ if woman is naive
- previously exposed => overall reduction of 44 % in disease related to other HPV types
- Males: Studies have demonstrated 90% efficacy in the prevention of external genital warts in males aged 16 – 23
12
Q
Cervarix: efficacy
A
- Seroconversion to the HPV types included in the vaccine is 100% and protection against CIN 2 and 3 and adenocarcinoma caused by HPV types 16 and 18 is 93%.
- Somehow gives better protection for another strain of HPV (31, 45) that causes cancer
13
Q
Provider impact on HPV vaccine administration
A
- Most likely to recommend when providers have a positive attitude about the behavior, when they feel their opinion is supported by trusted colleagues and professional organizations, and when they feel they have control over its implementation.
- Recommendation ↑ with age of patient, due to informed consent. Unfortunately, this ↓ efficacy if they become sexually active
14
Q
Parental impact on HPV vaccine administration
A
- Mostly receptive
- Biggest concern - “How will this affect my child’s sexual behavior?”
- Regression - down to the rest of the population
- Disinhibition - or even worse way too much sex.
- Parents from highly eclectic, subgroups reported being less likely to vaccinate
15
Q
Young adults impact on HPV vaccine administration
A
- Studies in this population find that HPV vaccination is generally well accepted.
- One survey provided 340 college students with information about HPV found that
- 75% of women and 33% of men would agree to a vaccination covering HPV 16 & 18.
- Acceptance rates ↑ to 90% and 75% when coverage was broadened to include HPV 6 and 11.
- The intention to receive the vaccine was greater among participants scoring higher on an HPV knowledge test and with more than five lifetime sexual partners.
