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30 Cards in this Set

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Epidemiologic info about cervical cancer?
2nd leading killer cancer worldwide. WHY? Because of improper screening tools. example. 50% of women with cervical cancer in US NEVER HAD A PAP

2nd leading killer in US women 20-39.
What is the screen test for HPV/cervical cancer/
PAP smear. Highly effective screening tool.

Can identify noncancerous lesions.
What is the transformation zone and does it change position with age?
Site where PAP smear is collected. Located at squamocolumnar junction.

MOVES UP THE ENDOCERVIX with age.
What will normally be observed during microscopic evaluation of pap smear?

What happens to nuclei as they reach the surface
As is common with squamous epithelium, cells die as they move up in the cell layer and are sloughed off.

You will see cells with varying size nucleus. The smaller and darker the nucleus is, the closer it is to the surface. MOST SUPERFICIAL = SUPERFICIAL cell.

Basal --> Parabasal --> Intermediate --> Superficial
Do high grade lesions regress as easily as low grade lesions?
NO!

Low grade lesions tend to regress normally. High grade lesions CAN REGRESS, but usually will not.
On the microscope, how can you identify high and low grade lesions/
Normally, only SMALL NUCLEI ARE DARK.

However, if you start to see LARGE, BLACK NUCLEI, this means that cells aren't differentiated/aging as they move up
What are some risk factors for cervical cancer?
HPV!

Age of first intercourse...number of partners...smoking
What is the difference between the mechanisms of action of CANCEROUS HPV and BENIGN HPV
CANCEROUS HPV integrates into host DNA. HPV's persistence is required for transformation.

BENIGN HPV usually is FREE
What do the viral E6 and E7 genes of HPV do?
They interrupt cell cycle regulation.

THey interrupt cell death signalling.

Increased growth and decreased death.
Is HPV sufficient to cause cervical cancer/
NO!

Necessary yes. Sufficient no.
Which is used in cytology, which is used in histology/biopsy?

SIL & CIN
CIN is biopsy/histology

SIL is cytology
What is the management of LSIL?
Colposcopy with ENDOCERVICAL CURETTAGE (ECC).

If colposcopy is satisfactory, then PAP every 6 months with re-triage to colposcopy if necessary for 2 years. After 2 years of normality, can return to normal screening.

IF colposcopy is BAD, then treat accordingly.
What is the likelihood that a CIN 1 will progress to invasion?
~0-1%
How do you manage HIGH GRADE lesions?
1) Colposcopy with ECC

IF COLPOSCOPY IS SATISFACTORY
2) If no CIN/cancer, then excise or treat according to guidelines.

3) If yes cancer, then manage accordingly
What do you expect to see in colposcopic image?
Coarse punctuations.

Dense white epithelium that goes ALL THE WAY AROUND the cervix.

High grade dysplasia

Unsatisfactory image
What is the likelihood of progression to invasion of a CIN 2 and CIN 3 tumor?
CIN 2 = 5%

CIN 3 = >12%
How would you treat a patient with CIN 3 lesion.
EXCISION!

Loop electorsurgical excision procedure (LEEP) or conization (if women still want to be pregnant)
Is a CIN 3 diagnosis cancer?
NO! But getting close. 12% go on to invasion
Once a tumor has passed stage 2, is hysterectomy indicated?
No...stage 3 indicates regional and potential lymph node involvement.

Makes more sense to do chemo or radiation.
What is an ASC-US in terms of PAP SMEAR?
atypical squamous cells of undetermined significance.

Differential diagnosis includes LSIL. 5-20% of patients will have HSIL on f/u.
What is an ASC-H in terms of PAP SMEAR?
atypical squamous cells - cannot exclude HSIL

24-96% will have HSIL on f/u.

Differential includes HSIL. Manage with colposcopy?
What is the importance of HPV reflex test in relation to ASC-US
ASC-US has a low potential for malignant transformation.

HOWEVER, current management options are both aggressive and expensive.

REFLEX HPV testing is a high SENSITIVITY (key) test for high risk HPV types. Performed in conjunction with cytology/pap.

SHOULD REDUCE COSTS of managing ATYPICAL PAPS!
Which of the following abnormalities is treated with ROUTINE SCREENING ONLY?
ASC-US with negative HPV result.

LSIL/HSIL/ASC-US with +HPV all undergo colposcopy.
Why is HPV testing not necessarily useful?
Prevalence of HPV+ individuals is EXTREMELY HIGH.

Would not reduce noise OR ANXIETY.
What is the mechanism of action of HPV vaccine?
Induction of neutralizing antibodies.

NON-LIVE.
When is it recommended to vaccinate girls?
11-12 years old (before sexual intercourse)
Which are the bad two types of HPV and which are the wart two types?
16,18 = oncogenic

6,11 = warty.
Is the HPV vaccine effective against individuals already infected?
NO.
What is the best thing a patient can do for their own care?
FOLLOW-UP!
When to start doing pap smears?
at 18 or upon initiation of sexual intercourse.