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72 Cards in this Set
- Front
- Back
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Top 4 predicted cancer deaths in women in USA
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lung
breast ovary cervix |
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Risk factors for Cervical Cancer
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1st intercourse during adolescent yrs (<20y/o)
multiple sexual partners (>2) cigarette smoking previous abnormal cervical smear/bx (CIN) immunosuppression - HIV, chronic steroid use STIs lack of previous PAP smear (>3yrs) nutritional deficiencies - etoh, folate deficiency conception at young age viral infections - HPV, HSV high risk male consort |
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What is the MC STI?
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HPV
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Which types of HPV are benign condyloma and causes low risk anogenital warts?
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HPV-6 and HPV-11
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What type of HPV is mc oncogenic type and causes most cervical squamous cancers?
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HPV-16
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What type of HPV is most prevalent high risk type in cervical adenocarcinoma?
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HPV 18
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What are the ways to lower the risk of HPV?
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avoid sexual contact
limit sexual partners long-term relationship with someone without HPV condom use routine PAP smears |
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Indications for use of Gardasil
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females and males age 9-26 for prevention of dz causes by HPV types 6, 11, 16, and 18
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What diseases are being prevented in females and males with Gardasil
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females: cervical cancer, genital warts, cervical adenocarcinoma in situ, cervical intraepithelial neoplasia grade 2&3, vulvar intraepithelial neoplasia grade 2&3, vaginal intraepithelial neoplasia grade 2&3, cervical intraepithelial neoplasia grade 1
males: genital warts |
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What is the dosage and administration of Gardasil?
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1st dose: day 1 0.5ml IM
2nd dose: 2mo 0.5ml IM 3rd dose: 6mo 0.5ml IM |
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Indications for use of Cervarix
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approved for use in females 10-25y/o for prevention of cervical cancer, cervical intraepithelial neoplasia >2 grade, adenocarcinoma in situ, and cervical intraepithelial neoplasia grade 1 caused by oncogenic human
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What is the dose and administration of Cervarix?
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3 doses of 0.5ml each IM on 0, 1, 6 mo in the deltoid region of upper arm
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S/S of Cervical Cancer
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post-coital bleeding
irregular bleeding pain |
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T/F: Detection and simple local tx of pre-invasive cervical dz can prevent invasive cancer
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True
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T/F: Reg cervical cancer screening programs have shown significant dec in mortality from cervical cancer
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True
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Who invented the PAP smear?
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Dr. George Papanicolaou
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What is the causative agent of cervical cancer?
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Human Papillomavirus (HPV)
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What is Grade A recommendation by USPSTF for cervical screeing?
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women ages 21-65 yrs with cytology (Pap smear) every 3 yrs/women ages 30-65 yrs who want to lengthen screening interval, screening with a combo of cytology and HPV testing every 5 years
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What is Grade D recommendation by USPSTF for cervical screening?
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against screening for cervical cancer in women <21 yrs
against screening for cervical cancer in women >65 yrs who have had adequate prior screening and aren't otherwise at high risk for cervical cancer against screening for cervical cancer in women who have had a hysterectomy with removal of cervix and who don't have hx of high-grade precancerous lesion/ cervical cancer against screening for cervical cancer with HPV testing, alone/in combo with cytology, in women <30 yrs |
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__ region on ectocervix btwn original squamous epithelium and glandular epithelium of endocervical canal that is site of most squamous pre-invasive and invasive neoplasms and undergoes transformation from mucus-secreting glandular cells to non-mucus secreting squamous cells in process of metaplasia
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cervical transformation zone (TZ)/ squamocolumnar junction
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T/F: Metaplastic change is most active during menopause when elevated estrogen levels may be stimulus
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False (adolescence and pregnancy)
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What are benign changes of cervix?
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nabothian cysts-domed, glassy surface& mucus middle
cervical polyps ectropion |
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What are the common causes of false-negative PAP smears?
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sampling errors
screening errors diagnostic errors laboratory errors |
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Classification of abnormal squamous cell cytology on PAP
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class I - normal
class II - inflammatory atypia class III - dysplasia class IV - carcinoma in situ class V - invasive carcinoma |
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cervical intraepithelial neoplasia (CIN) classification
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CIN I - mild dysplasia
CIN II - moderate dysplasia CIN III severe dysplasia and carcinoma in situ (CIS) 20% of CIS go on to microinvasive cancer to invasive cancer |
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What updated the classifications for reporting cervical and vaginal diagnoses and what are the advantages of this updated method?
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Bethesda System 2001
-clearly separates benign changes caused by reactive/inflammatory processes from true epithelial abnormalities -replaced CIN and dysplasia nomenclature with squamous intraepithelial lesion -includes HPV effect in LSIL category |
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What is the format of Bethesda Report?
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specimen type (smear vs liquid based)
specimen adequacy general categorization automated review ancillary testing interpretation/results |
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__ is inspection of TZ and squamocolumnar junction under magnification following application of 3-5% acetic acid soln that has reduced number of cone bx done
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colposcopy
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What is performed in conjunction with colposcopy to r/o dysplasia within canal that is colposcopically unapparent?
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endocervical canal curettage (ECC)
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__ is a photo of cervix taken after acetic acid applied and sent to lab for reading that is highly sensitive, low specificity, and more expensive than PAP
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cervicography
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__ is more sensitive for HSIL than PAP and recommended for women >30y/o
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high risk HPV DNA & PAP test
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__ use neural network technology to recognize and photograph abnormal cells and claims to find 5-7x abnormal cells as current screening methods
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Computerized Automatic PAP Smear Screening (PapNet and AutoPaP)
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T/F: All women with smear that isn't normal, should undergo colposcopically directed bx and ECC before tx options are considered
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True
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T/F: Conization may be necessary if results of colposcopy are equivocal; otherwise cryotherapy, laser, and LEEP are tx options and choice depends on extent of lesion
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True
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What is the tx of abnormal PAP smear without dysplasia but with squamous/koilocytic atypia?
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repeat PAP smear q 6mo, and perform annual colposcopy
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What is the tx of abnormal PAP smear of cervical dysplasia with squamocolumnar junction?
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with negative ECC, outpatient local destruction of TZ (cryo, laser vaporization)
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What is the tx of abnormal PAP smear of cervical dysplasia with non-visualized squamocolumnar junction/ positive ECC?
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outpatient cone bx of cervix
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What is the tx of abnormal PAP smear of microinvasive carcinoma?
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cone bx
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T/F: LSIL has potential for progression to invasive cervical cancer in up to 33% of women within 2-15yrs if left untreated
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False (mild dysplasia, CIN I, CIN II, and CIN III)
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What are the cure rates for 1 tx?
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85-96%
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What is the cure rate for repeat tx of adequately evaluated persistent lesion?
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95%
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What is the risk of lesions persisting/recurring in post tx follow up?
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5-15%
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__ has a depth of invasion of <3mm with no lymphovascular space involvement and no confluent tongues of tissue
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microinvasive carcinoma of cervix
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dx and tx of microinvasive carcinoma of cervix
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dx: cone bx
tx: total abdominal hysterectomy (95% cure rate) |
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Sx of invasive carcinoma
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postcoital/irregular bleeding (mc)
malodorous, bloody discharge, and deep pelvic pain (locally advanced dz) mean age 45 squamous carcinomas (85%) and adenocarcinoma (13%) |
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5 yr survival of invasive cervical carcinoma
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Stage I: 85-99%
Stage II: 68-80% Stage III: 36-45% Stage IV: 2-15% |
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Tx of invasive carcinoma of cervix
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depends on patient's age, general health, and clinical stage of cancer
primary modalities - surgery and RT ~35% have persistent/recurrent dz |
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__ is mc pelvic genital cancer in women with mean age 61 and mc sx of irregular menses/postmenopausal bleeding
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endometrial carcinoma
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risk of endometrial carcinoma
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obesity
chronic anovulation/PCOS/nulliparity granulosa-theca cell ovarian tumors exogenous unopposed estrogen endometrial hyperplasia late menopause tamoxifen breast/ovarian cancer |
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What is thought to be precursor to endometrial carcinoma, has a risk of progression of 1-14% if untreated, and greatest risk in postmenopausal women/ women with atypical adenomatous hyperplasia?
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endometrial hyperplasia
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tx and prevention of endometrial hyperplasia
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tx: cyclic estrogen with progestin, hysterectomy
prevention: estrogen replacement therapy (medroxyprogesterone) |
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What are the mc endometrial cancers?
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adenocarcinoma (60%) and adenocanthoma (22%)
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dx an tx of endometrial cancer?
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dx: fractional dilation and curettage*, bx, hysteroscopy with bx
tx (based on health and stage): total abdominal hysterectomy, bilateral salpingo-oophorectomy, peritoneal cytology, estrogen/progesterone assessment, pathologic evaluation, postoperative RT |
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__ is 5th leading cause of CA death women in US; incidence starts to rise 5th decade and continues to 8th decade; postmenopausal women at high risk; silent in early development; no dependable serodiagnostic screening test other than periodic pelvic exam (no CA-125 antigen level)
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ovarian cancer
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What is the mc type of ovarian cancer?
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epithelial tumors - serous cystadenoma
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__ is ascites, hydrothorax, and ovarian fibromas
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Meigs' syndrome
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ovarian cancer risk factors
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early menarche
late menopause nulliparity fhx (biggest) >50 y/o Caucasians and Hawaiians hx of breast/uterine CA |
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S/S of ovarian cancer
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pressure, abdomen enlargement, vague GI complaints, painful micturition, painful defecation, tenesmus, dyspareunia, back pain, fatigue, indigestion, triad (bloating, inc ab size, urinary freq)
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dx of ovarian cancer
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s/s
pelvic exam pelvic US CA 125 level elevated B-hCG, A-fetoprotein, LDH abdominopelvic CT scan, barium enema, CXR *surgical staging eval (exploratory laparotomy, peritoneal washings, inspection, pelvic/para-aortic lymph node sampling, omentectomy, wedge bx) |
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tx of ovarian carcinoma
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depend on category of tumor and stage
surgery, intraperitoneal instillation, whole abdominopelvic RT, tumor debulking, 2nd look laparotomy |
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5 yr survival rates of ovarian carcinoma
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Stage I: 66.4- 73%
Stage II: 45% Stage III: 13.3% Stage IV: 4.1% |
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__ is rare; mc type of squamous cell carcinoma; sx of vaginal discharge (mc) and urinary sx occurring btwn 35-70y/o
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vaginal cancer
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tx of vaginal cancer
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primarily RT
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5 yr survival rates of vaginal cancer
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Stage I: 65%
Stage II: 60% Stage III: 35% Stage IV: 9% |
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Original indication for DES
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high risk pregnancies - DM, habitual abortion, threated abortion, prevent pregnancy wastage
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Complication of DES
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clear cell adenocarcinoma
cervix (40%) and upper 1/2 vagina (60%) |
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tx of DES related adenocarcinoma
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radical hysterectomy
upper vaginectomy with pelvic lymphadenectomy RT |
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risk factors of vulvar carcinoma
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vulvar condylomata/granulomatous STI hx
carcinoma in situ cervix/vagina invasive squamous cell CA tx 60-79y/o |
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sx of vulvar carcinoma
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lack of recognition
hx of chronic vulvar irritation/soreness visible lesion on labia (often sore) |
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MC type of vulvar carcinoma
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squamous carcinomas (90%)
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dx and tx of vulvar carcinoma
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dx: incisional/excisional bx
tx: local excision, radical vulvectomy, pelvic RT |
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5yr survival rate for vulvar carcinoma
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Stage I: 71.4%
Stage II: 47.2% Stage III: 32.0% Stage IV: 10.5% |
