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Repro / GU > SM_218b: Vulvar and Cervical Malignancy > Flashcards

SM_218b: Vulvar and Cervical Malignancy Flashcards

1
Q

Describe common risk factors for cervical cancer and its precursor lesions

A

Common risk factors for cervical cancer and its precursor lesions

  • Early age at first coitus
  • Infection with high-risk HPV
  • Early age at first pregnancy
  • Lack of routine cytologic screening
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2
Q

Pap smear is ____ and allows for ____

A

Pap smear is liquid-based and allows for reflex testing (HPV)

  • Sensitivity: > 95%
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3
Q

Describe cervical cytology terminology

A

Cervical cytology terminology

  • NILM: no intraepithelial lesions or malignancy
  • ASC-US: atypical squamous cells of unknown significance
  • LSIL: low-grade squamous intraepithelial neoplasia
  • HSIL: high-grade squamous intraepithelial neoplasia
  • ASC-H: atypical squamous cells, cannot exclude high-grade lesion
  • AGC: atypical glandular cells
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4
Q

Describe benchmarking for risk in cervical cancer screening

A

Benchmarking for risk in cervical cancer screening

  • NILM: routine screening every 3 years
  • ASC-US: short interval screening
  • LSIL: immediate colposcopy
  • HSIL: immediate colposcopy
  • ASC-H: immediate colposcopy
  • AGC: immediate colposcopy with EMB
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5
Q

Low-grade HPV is ____ and ____

A

Low-grade HPV is 6 and 11

(genital warts)

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6
Q

High grade HPV is ___ and ___

A

High grade HPV is 16 and 18

(high grade dysplasia / cancer)

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7
Q

Circular dsDNA, non-enveloped, icosahedral capsid is ____

A

Circular dsDNA, non-enveloped, icosahedral capsid is HPV

  • Sexual, skin-to-skin contact
  • Persistent HPV infection increases risk of dysplasia or cancer: 80-90% cleared by 18 months
  • HPV infection is common
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8
Q

Describe the use of HPV testing

A

Use of HPV testing

  • Better sensitivity for CIN2 and CIN3 and better reproducibility than cytology
  • Diagnostic uses: triage of ASCUS pap and more sensitive for detecting HGSIL, triage of postmenopausal LGSIL, post treatment screening
  • Co-testing: HPV testing + cytology: increased detection of CIN3, improves detection of cervical cancer, enhances detection of adenocarcinoma
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9
Q

Describe the algorithm for cervical cytology / HPV testing

A

Algorithm for cervical cytology / HPV testing

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10
Q

In colposcopy, focus on the ____

A

In colposcopy, focus on the transformation zone

(area between normal columnar epithelium and mature squamous epithelium)

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11
Q

Describe indications for conization (loop electrosurgical excision) indications

A

Conization (loop electrosurgical excision) indications

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12
Q

CIN 2 and CIN 3 are more likely to ___ than CIN 1

A

CIN 2 and CIN 3 are more likely to progress / persist than CIN 1

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13
Q

Describe what makes the pap smear a successful screening tool for cervical cancer

A

Pap smear is a successful screening tool for cervical cancer

  • Cervical cancer is common
  • Untreated CIN3 has a 30 year risk of progression to invasive CA of 30% compared to < 1% for treated CIN3
  • Dysplastic lesions can be detected for 5-10 years prior to progression
  • Pap smear has sensitivity > 95% for detecting squamous lesions ≥ CIN2
  • Pap smear requires a pelvic examination and a pathologist trained in its interpretation
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14
Q

Describe symptoms of cervical cancer

A

Cervical cancer symptoms

  • Commonly: abnormal vaginal bleeding, post-coital bleeding, vaginal discharge
  • Advanced disease: pelvic pain, difficulty urinating / defecating
  • Metastatic: back pain, one sided leg swelling
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15
Q

Describe physical exam findings of cervical cancer

A

Cervical cancer physical exam findings

  • Visiaully: necrotic, friable lesion on cervix
  • Staging is clinical
  • Biopsy confirmation
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16
Q

Describe treatment recommendations for cervical dysplasia and cancer

A

Treatment recommendations for cervical dysplasia and cancer

  • Low grade dysplasia: surveillance vs non-excisional treatment
  • High grade dysplasia: excisional (cervical conization or hysterectomy)
  • Cervical cancer diagnosed on biopsy: surgery for microscopic disease, radical surgery for small tumor (< 2-4 cm) confined to uterus, radiation with sensitizing chemo for locally advanced tumor, chemo for distant metastatic disease
17
Q

Care must be taken to avoid injuring the ____, ____, and ____ when performing pelvic lymphadenectomy for cervical cancer

A

Care must be taken to avoid injuring the common iliac artery, obturator nerve, and ureter when performing pelvic lymphadenectomy for cervical cancer

18
Q

As FIGO stage of cervical cancer increases, survival ____

A

As FIGO stage of cervical cancer increases, survival decreases

19
Q

Most common cervical cancer risk factor is ____

A

Most common cervical cancer risk factor is a lack of cervical cancer screening

  • HPV vaccines are effective in the prevention of cervical dysplasia
20
Q

Compare HPV and non-HPV associated vulvar cancer

A

HPV and non-HPV associated vulvar cancer

  • HPV-associated: HSIL (VIN-2/3), younger age (< 55 yo), smoking, low SES, high risk sexual behaviors, HIV
  • Non-HPV associated: chronic inflammatory disease (lichen sclerosis)
21
Q

Lichen sclerosis is a ____

A

Lichen sclerosis is a complex chronic inflammatory skin condition

  • Considered autoimmune
22
Q

Severe pruritis, vulvar irritation, pain, and dyspareunia is ____

A

Severe pruritis, vulvar irritation, pain, and dyspareunia is lichen sclerosis

23
Q

Describe appearance of lichen sclerosis on physical exam

A

Lichen sclerosis on physical exam

  • Porcelain white (hypopigmentation) papules and plaques, often with areas of ecchymosis, purpura, and excoriation
  • Shiny, waxy, thinned, whitened, and crinkling (cigarette paper)
  • CHanges in vulva: loss of labial contours and fusion of labia minoria into labial fat pad
24
Q

This is ___

A

This is vulvar / perianal condyloma (LSIL)

25
Q

Describe treatment of vulvar cancer

A

Vulvar cancer treatment

  • Current surgical management: triple incision vulvectomy / wide local excision
  • Radical vulvectomy: depth of the perineal membrane / periosteum of pubic symphysis
  • Radical vulvectomy: butterfly vs longhorn
  • For advanced disease: neoadjuvant chemoradiation
  • Inguino-femoral lymph node dissection performed in all stages except IA
26
Q

Postmenopausal Caucasian woman with eczematoid red weeping area on vulva has ____

A

Postmenopausal Caucasian woman with eczematoid red weeping area on vulva has Paget’s disease

  • 15% have underlying vulvar adenocarcinoma
  • 20-30% will develop metastatic disease
  • Treatment: WLE

Repro / GU (46 decks)

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