2.1 Cs Exam4: Cervical Dysplasia & Vulvular Cancer

Front 1

what are the risk factors for HPV?

Back 1

1) young age at first coitus (<20)
2) multiple sexual partners
3) sexual partner w/ multiple sexual partners
4) young age at 1st pregnancy
5) High parity
6) smoking, lower socioeconomic status
7) immunosuppression- AIDs defining illness

Front 2

What are the high risk types of HPV? low risk types? what do they cause?

Back 2

high: 16, 18- cervical cancer
low: 6 and 11- genital warts and anal cancer

Front 3

22 year old female presents to your office HPV positive, do you think this will be a transient or a persistent strand of HPV?

Back 3

transient- in teens and early 20s, think transient
in 30s think- persistence.

Front 4

what is the Gardasil vaccine?

Back 4

quadrivalent vaccine w/ HPV strands 6,11,16, & 18

given to females and males ages 9-26 via IM injection at 0, 2 and 6 months. Most effective if given before onset of sexual activity.

Front 5

when should someone start receiving a pap smear?

what are the intervals that they should get them?

Back 5

start at age 21

interval:

every 2 years from 21-29 (w/o HPV screen)
every 2-3 years over 30 (w/o HPV screen)

or

every 3-5 years over 30 w/ HPV screen

Front 6

when can you discontinue giving a pt pap smears?

Back 6

-hysterectomy for non-cancer reason
-age > 65 and low risk w/ prior adequate screening

Front 7

_____ of women diagnosed with cervical cancer every year never had cytology testing

Back 7

50%

Front 8

When do you do HPV screening?

when would you do an HPV reflex test?

Back 8

HPV screening- pts > 30 yrs

HPV reflex test- If a pt 21-30 yrs old comes back w/ an abnormal pap smear

Front 9

what are the main types of bethesda classifications of epithelial cell abnormalities?

Back 9

pap smear results that come back with squamous or glandular cells*

Front 10

what is CIN 1? 2? 3 (bethesda classifications)?

Back 10

CIN1- mild dysplasia- low grade intrathelial lesions will regress on own 60% of time
CIN2- moderate dysplasia- high grade intrathelial lesions
CIN3- severe dysplasia or carcinoma in-situ- less likely to regress on own.

Front 11

what is colposcopy?

Back 11

add 3-5% acetic acid to cervical scraping-->

evaluate surface epithelium & subepithelial blood vessels using binocular microscope-->

identify transformation zone & determine if malignant cells are present

(cells turn white= cancer)

Front 12

When is colposcopy indicated?

Back 12

-persistant atypical squamous cells of undetermines significance (ASC-US) (on multiple paps))

-ASC-US & + HPV (16 or 18)

-Atypical squamous cells suggestive of high-grade lesion (ASC-H)

-Atypical glandular cells (ACG)

-Low-grade squamous intrapepithelial lesions (LSIL)

-High grade ^ (HSIL)

-Suspicion for cancer

Front 13

what are the 5 indications for a diagnostic cone biopsy?

Back 13

Unsatisfactory colposcopy
Endocervical curetting show a high grade lesion
Pap smear shows high grade lesion not confirmed by biopsy
Pap smear indicate adenocarcinoma in situ
Microinvasion is present on biopsy

Front 14

what are the two types of excisional procedures? which one is more useful? which one is more dangerous?

Back 14

1) loop electrosurgical excision procedure (LEEP)- gets tissue -- a little less useful because you are destroying the margin histology. Requires local anesthesia.
2) conization (laser or cold knife)- diagnosis, general anesthesia & can cause cervical stenosis and cervical incompetence which increases infertility. --> more dangerous.

Front 15

what are the signs and sxs of cervical cancer?

Back 15

Abnormal vaginal bleeding
Postcoital bleeding
Vaginal discharge
Pelvic pain
Leg swelling
Urinary frequency
Fistula formation – loss of urine or stool from the vagina- late sign

Front 16

45 year old female presents w/ weight loss, enlarged LN, ascites and post-coital bleeding. What would you expect to find on a pelvic exam?

Back 16

ulcerative and necrotic tissue. A friable (breaks off easily and bleeds) cervix.

Front 17

what 2 exams would you do in a physical exam of a pt presenting with the signs and symptoms of cervical cancer?

Back 17

Pelvic and rectovaginal exam.

Front 18

what are the three patterns of spread of cervical cancer?

Back 18

1) direct invasion (cervical stroma, uterine corpus, vagina, parametrium)
2) lymphatic spread (pelvic--> paraaortic lymph nodes)
3) Hematogenous spread (lung, liver, bones)

Front 19

what are the tx options for cervical cancer?

Back 19

surgery- conization--> hysterectomy
radiation therapy

Front 20

60% of Vulvar cancer is related to what types of HPV?

Back 20

16 & 33

Front 21

what is the mean age of vulvular cancer?

what are the clinical manifestations?

Back 21

65 years of age (post menopausal)

clinical manifestations:

-vulvar plaque, ulcer, or mass

-pruritus (itching)

-bleeding, dysuria, enlarged LN

Front 22

what type of cell is most common in invasive valvular carcinoma?

What are the risk factors?

Back 22

Squamous cell carcinoma

smoking, multiple sexual partners, HIV, early age of first sexual intercourse

Front 23

what is bowenoid papulosis? how do you tx?

Back 23

type of squamous cell carcinoma that affects the younger population.

Has multiple reddish brown or violaceous papules.

tx: local excision and laser therapy.

Front 24

What causes clear cell adenocarcinoma (another type of vulvular cancer)?

Back 24

DES exposure in utero (mom taking DES causes daughter to have clear cell adenocarcinoma)

or

Pagets diseae

Front 25

65 year old white female presents w/ itchiness and tenderness of the nipples. Upon examination you notice that her nipples have quite a bit of eczema. What is this dz usually associated w/?

Back 25

Paget's dz is usually associated w/ clear cell adenocarcinoma.

Front 26

what are the 2 ways you can manage valvular cancer?

Back 26

1) surgical excision
2) vulvectomy