Repro wk 4 - neoplasia Flashcards
screening guidelines in BC for cervical cancer: when should they begin?
at age of 21 or 3 years after sexual debut ( where sexual means any skin to skin contact)
you obtain a pap smear on your 17 yr old patient, and the smear is report as mile squamous dyskariosis/ LSIL. The patient asks you what chance there is that the pap smear is mistaken. you say, the false positive rate for pap is:
less than 1%.
generally, pap smears are considered an excellent screening tool.
when you obtain a pap, it is important to sample all of the transformation zone. what is the transofrmation zone and why do we swab it?
TZ zone is the area extending between the original ( anatomical) squamocolumnar junctino and the new ( physiologic) squamocolumnar junction, where 80% of squamous cervical cancer originate.
what transformation occurs in the TZ zone>
conversion from a columnar cell to a stratified squamous cell. when the columnar cells are exposed to the acidic/ bacterial vaginal environment, they metaplase and get cancerous sometimes
your patient is a 43 yr old widowed woman who feels that is not at risk for cervical cancer, you recall what the risk factors for cervical cancer are:
multiple sex partners, history of STI, smoking, previous abnormal paps,
NOT low parity - the amount of kids youve had dont matta. a woman who has been sexually active in her lifetime is always at risk of cervical cancer, even i she is not currently sexually active or has not been for a long time.
HPV 6 and 11 are associated with?
flat condyloma, condyloma acuminatus, mild cervical dysplasia, spontaneous regression of lesions in 30-50% of cases,
not associated with cervical carcinoma! we vaccinate people against 16 and 18.
cervical intraepithelial neoplasia grade 2/ CIN 2 is defined by :
basaloid type dysplastic cells in the lower 2-3 of the epithelium
a patient is referred to teh colposcopy clinic with a pap smear reporting severe squamous dyskarisis. a biopsy of a suspiscious area is reported as carcinoma in situ. On microscopy, carcinoma in situ of the cervix shows:
loss of cellular maturation on the surface
a 32 year old woman presents to the colsposcopy clinic with a pap smear reporting moderate squamous dyskariosis/ HSIL. the exam was satisfactory and the cervical biopsy was reported as CIN 2. approrpriate treatments for this patient would include all the following except:
observation.
you cant just watch and wait a CIN2, you need to do LEEP, laser vaporiazation of the transformation zone or cryosurgery
cone biopsy is indicted if:
1) the entire TZ zone cant be visualized,
2) the entire lesion cannot be visualized
3) the endocervical curetting procedure reports severe squamous dysplasia
what does cone biopsy help you differentiate between?
1) preinvasive disease ( dysplasia, carcinoma), microinvasive disease, or frank invasion
the most common symptom of certical cancer is:
POST COITAL BLEEDING
a 50 yr old woman is diagnosed with cervical canecr. which lymph node group group be the first involved in metastatic spread of the disease beyond the cervix uterus?
paracervical or ureteral nodes
what investigations are used to stage cervical cancer?
cytoscopy, sigmoidoscopy, chest x ray, liver functions test
—we DONT use CT though
cervical caner staging: the patient has involvement of upper portion of the vagina, with node involvedment in the pelvis and periaortic area
apparently this is stage II
what is a common presentation of molar pregnancy?
abnormal vaginal bleeding, and a uterus that is large for the dates. there may be a high BHCG, which will cause nausea, vomiting, and pregnancy-induced hypertention. however ausculation of the uterus will reveal absence of fetal heart sound
how do you diagnose molar pregnancy?
pelvic ultrasound, reporting the classic snowstorm pattern
a 35 yr old white female presents with positive pregnancy test. hre uterus is large for dates, and ultrasound shows snow storm pattern and no fetus. she has:
complete hydatidiform mole, molar pregnancy
how do you know if youve found a partial mole/ partial molar pregnancy. what is the difference between complete and partial mole?
partial mole = 2 sperm and 1 egg, so there is fetal tissue. this is how you know you have found a partial mole, you will see molar tissue adjacent to a living to dead fetus.
complete mole = two sperm fertilized an empty or deactivated egg = no fetal tissue.
the most common chromosomal pattern present in completel hydatidiform moles is:
46XX paternal homologous ( diantric diploidy) = two sperms fertilized an inactive/ empty egg
how do you treat molar pregnancy?
evacuation of uterine contents, and then contraception because we watch for cancer with rising bHCG.
the most common sympto of endometrial hyperplasia is:
vaginal bleeding. you usually get the endometrial hyperplasia due to unopposed estrogen, but there are also the type II non estrogen related endometroid cancers..
endometrial adenocarcinoma is most often preceeded by which:
complex endometrial hyperplasia with cytologic atypia
what endometrial cancer risk factor is not associated with estrogen?
hypertension.
