Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
100 Cards in this Set
- Front
- Back
|
where is squamous epithelium found?
|
vagina
|
|
|
where is columnar epithelium found? (2)
|
endocervix and central ectocervix
|
|
|
what is the transformation zone?
|
area of metaplastic squamous epithelium between the original squamocolumnar junction and new squamocolumnar junction
|
|
|
what is the average age of onset of cervical cancer?
|
47
|
|
|
why is cervical cancer rare before age 20?
|
transient HPV infections
|
|
|
what type of virus is HPV?
|
double stranded DNA
|
|
|
how is HPV transmitted?
|
skin to skin contact
|
|
|
what are the 2 high risk HPV types?
|
16
18 |
|
|
what are the 2 low risk HPV types?
|
6
11 |
|
|
what are 7 risk factors for cervical cancer?
|
young age at first coitus
multiple partners sexual partner with multiple partners young age at first prengnacy high parity lower socioeconomic status smoking immunosuppression |
|
|
how long does it usually take for dysplasia to progress to invasive cancer?
|
10 years
|
|
|
what 4 factors indicate whether HPV will progress to cancer?
|
type of HPV
persistence smoking compromised immune system |
|
|
when should pap smears begin?
|
21
|
|
|
how often should 21-29 year olds get pap smears?
|
every 2 years
|
|
|
what 4 requirements must women over 30 meet in order to only get paps every 2-3 years?
|
3 consecutive negative paps
No HIV or immunosuppression No CIN 2 or CIN3 No DES exposure |
|
|
when should you test for HPV and do a pap?
|
in women over 30
|
|
|
what does guarasil protect against?
|
HPV 6, 11, 16, and 18
|
|
|
who is guardasil indicated in?
|
men and women 9-26
|
|
|
when should guardasil be given?
|
0, 2, 6 months
|
|
|
when is guardasil most effective?
|
before onset of sexual activity
|
|
|
in what 3 conditions can you discontinue paps?
|
hysterectomy for non-cancer reason
age 65-70 and low risk 3 negative paps in last 10 years |
|
|
which test allows for HPV test and Pap?
|
thin prep (a liquid based medium)
|
|
|
which test has an 80% sensitivity?
|
thin prep
|
|
|
what is the order of the bethesda classification?
|
ASCUS
LSIL HSIL squamous cell CA ACG endocervical adenocarcinoma in situ adenocardinoma |
|
|
what is the most benign finding in the bethesda classification?
|
ASCUS
|
|
|
what is the most severe finding in the bethesda classification?
|
adenocardinoma
|
|
|
what is ASCUS?
|
atypical squamous cells of undetermined significance
|
|
|
what is the reflex test for ASCUS or above?
|
HPV testing
|
|
|
what instrument is used for colposcpy
|
binocular microscope
|
|
|
what solution is used for colposcopy?
|
3-5% acetic acid
|
|
|
what 4 things can you do with colposcopy?
|
evaluate surface epi and sub-epi blood vessels
identify transformation zone biopsy suspicious lesions endocervicalcurettage |
|
|
what is CIN I?
|
cervical intraepithelial neoplasia grade 1
mild dysplasia |
|
|
what is CIN 3?
|
cervical intraepithelial neoplasia grade 3?
severe dysplasia |
|
|
if cytology and HPV are negative, what if the next step?
|
routine screening every 3 years
|
|
|
if cytology is negative but HPV is positive, what is the next step?
|
repeat both tests at 12 months
|
|
|
if cytology shows ASCUS but HPV is negative, what is the next step?
|
repeat cytology at 12 months
|
|
|
if cytology shows ASCUS and HPV test is positive, what is the next step?
|
colposcopy
|
|
|
if cytology is greater than ASCUS and you have any HPV result, what is the next step?
|
colposcopy
|
|
|
what are 3 considerations for monitoring the cervix except for doing a procedure?
|
age of patient
desire for reproduction grade of dysplasia |
|
|
what are monitoring intervals for cervical dysplasia?
|
every 6 months
|
|
|
what type of ablative procedure do you use in CIN I?
|
cryotherapy
|
|
|
what type of ablative procedure requires local anesthesia?
|
laser
|
|
|
what kind of ablative procedure do you use for destruction of transformation zone by carbon dioxide?
|
laser
|
|
|
which excisional procedure requires local anesthesia?
|
loop electrosurgical excision procedure (LEEP)
|
|
|
what is a con of conixation? (2)
|
cervical stenosis
cervical incompetence |
|
|
what excisional procedure requires general anesthesia?
|
conization
|
|
|
if you have an unsatisfactory colposcopy what should you do next?
|
diagnostic cone biopsy
|
|
|
what are 7 signs of cervical cancer?
|
abnormal vaginal bleeding
postcoital bleeding vaginal discharge pelvic pain leg swelling urinary frequency fistula formation |
|
|
what can a loss of urine or stool from the vagina indicate?
|
fistula formation (cervical cancer sign)
|
|
|
what are 4 general physical exam findings of cervical cancer?
|
weight loss
enlarged lymph nodes edema of legs ascities |
|
|
what are 3 pelvic exam findings of cervical cancer?
|
ulcerative/exophytic/granular/necrotic
friable discharge |
|
|
why should you do a rectovaginal exam for cervical cancer?
|
to see if cervical cancer spread
|
|
|
where can cervical cancer spread do via direct invasion? (4)
|
cervical stroma
uterine corpus vagina parametrium |
|
|
where can cervical cancer spread do via lymphatic spread? (2)
|
pelvic
paraaortic lymph nodes |
|
|
where can cervical cancer spread do via hematogenous spread? (3)
|
lungs
liver bones |
|
|
what are 4 ways to stage cervical cancer
|
staging studies
lab findings surgical staging PET scan |
|
|
what are 2 main treatment options for cervical cancer?
|
surgery
radiation |
|
|
what are 2 radiation options for cervical cancer?
|
external beam
brachytherapy |
|
|
what are 2 types of brachytherapy for cervical cancer tx?
|
intracavitary
interstitial |
|
|
what is a simple total hysterectomy?
|
uterine corpus and cervix removed
|
|
|
what is a subtotal hysterectomy?
|
removal of uterine corpus at the level of the internal cervical os
|
|
|
what is a BSO hysterectomy?
|
bilateral salpingo-oophorectomy
|
|
|
who usualyl gets vulvar cancer?
|
post menopausal women
|
|
|
what is a key sign of vulvar intraepithelial neoplasia III?
|
itching
|
|
|
what are 2 treatment options for VIN III?
|
surgical excision
vulvectomy |
|
|
how do you diagnose VIN III? (3)
|
visual inspection
colposcopy biopsy |
|
|
who is bowenoid papulosis more common in?
|
younger population
|
|
|
what will bowenoid papulosis look like?
|
multiple reddish brown or violaceous papules
|
|
|
what is histologically indistinguishable from VIN III?
|
bowenoid papulosis
|
|
|
what are 2 treatment options for bowenoid papulosis?
|
local excison
laser therapy |
|
|
who is pagets disease most common in?
|
postmenopausal white women
|
|
|
where else on the body is pagets disease seen?
|
nipples
|
|
|
what are 2 treatment options for pagest disease?
|
local excison
laser therapy |
|
|
what are 3 key signs for pagets disease?
|
itchiness
demarcated, ecxematoid tenderness |
|
|
what is pagets disease associated with?
|
adenocarcinoma
|
|
|
what is the most common type of invasive vulvar carcinoma?
|
squamous cell
|
|
|
where is vulvar carcinoma most common?
|
labia majora
|
|
|
where can vulvar carcinoma spread to via direct extension? (3)
|
vagina
urethra anus |
|
|
where can vulvar carcinoma spread to via lymphatic spread? (3)
|
inguinal --> femoral nodes --> external iliac
|
|
|
where can vulvar carcinoma spread to via hematogenous spread? (3)
|
lungs
liver bones |
|
|
what are 5 treatment options for vulvar carcinoma?
|
radical local excision
radical vulvectomy groin dissection preoperative radiation or chemo postoperative radiation |
|
|
where is carcinoma in situ of the vagina seen?
|
upper third of vagina
|
|
|
what are 2 factors that increase the risk for VAIN?
|
previous cervical
vulvar carcinoma abnormal pap |
|
|
how is VAIN treated?
|
surgical excision
|
|
|
what is VAIN?
|
carcinoma in situ of the vagina
|
|
|
what are 3 symptoms of squamous cell carcinoma of the vagina?
|
abnormal vaginal bleeding
vaginal discharge urinary symptoms |
|
|
where should you examine for squamous cell carcinoma of the vagina?
|
upper third of vagina
|
|
|
what are you looking for on the physical exam for squamous cell carcinoma of the vagina?
|
ulcerative, exophytic, or infiltrative growth
|
|
|
where can squamous cell cancer of the vagina spread to via direct invasion? (4)
|
bladder
urethra rectum pelvic side wall |
|
|
where can squamous cell cancer of the vagina spread to via lymphatic spread from the upper vagina? (3)
|
obturator
hypogastric external iliac nodes |
|
|
where can squamous cell cancer of the vagina spread to via lymphatic sprad from the lower third of the vagina?
|
inguinofemoral nodes
|
|
|
where can squamous cell cancer of the vagina spread to via hematogenous spread?
|
it is uncommon
|
|
|
what are 4 ways to stage squamous cell cancer of the vagina?
|
CXR
IV pyelogram cystography sigmoidography |
|
|
what is the main treatment for squamous cell carcinoma of the vagina?
|
radiotherapy
|
|
|
when is surgical removal considered in the vagina?
|
when nodes are involved
|
|
|
where is surgery limited to in squamous cell carcinoma of the vagina?
|
early lesions in the posterior fornix
|
|
|
what is clear cell adneocarcinoma due to?
|
DES exposure in utero
|
|
|
what happens to the epithelium in those exposed to DES?
|
columnar epi extends onto the vaginal fornicies
|
|
|
how to you treat clear cell adenocarcinoma?
|
radical hysterctomy and vaginectomy
|
|
|
what is the mean age for clear cell carcinoma?
|
19
|
