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51 Cards in this Set
- Front
- Back
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What cancer serves as the model of a controllable cancer?
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carvical carcinoma
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What are some epidemiologic factors relating to cervical neoplasia?
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-early intercourse
-many sex partners -early childbearing -socioeconomic status, race -veneral infection |
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What are some other factor associated iwth cervical neoplasia?
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-immune status
-OCPs -cigarette smoking -intrauterine DES exposure |
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Understanding the pathophysiology of CIN and its association with the squamocolumnar junction (SCJ) and transformation zone (TZ) of the cervix provides the rationale for what?
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-cervical Pap smear screening
-diagnostic colposcopy -tx of CIN |
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The area between the old and new SCJs, where squamous metaplasia occurs, is calle dwhat?
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the transformation zone (TZ)
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In the menopausal years, the uterus and the cervix again decrease in size, and the new SCJ comes to upward into what?
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endocervical canal, often out of direct visual contact
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What is the most important risk factor fo rthe development of cervical cancer?
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HPV
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Which types of HPV are most connected to cancer?
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16. 18, 31, 33, and 45
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Which types of HPC are associated with genital warts?
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6 and 11
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In HPV, entire encapsulated virions are produced that are expressed morphologically as what?
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koilocytes
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The basis for classification of pap smears is what?
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the progression of precursor lesions to more advanced lesiono and eventually to cervical carcinoma and hence the window of opportunity for dx and tx
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Why is the evolution of atypical squamous cells challenging?
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bc of the imprecision with which they are classified and the often conflicting info about their appropriate evaluation and tx
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How can ASC-US be managed?
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-repeat cytology in 4 to 6 months
-immediate colposcopy -HPV testing |
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What is the preverred method for the management of ASC-CU?
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HPV testing
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Inflammation associated with intravaginal infection may be be appropriately managed by tx and what?
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repeat pap smear
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Immunosuppressed women with ASC-CU are best evaluated with what?
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colposcopy
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Why is ASC-H evaluated by colposcopy?
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because of the higher likelihood of underlying CIN 2-3 lesion
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Endometrial carcinoma rates are ____ that for invasive cervical carcinoma.
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twice that
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What is the average at dx for invasive cervical cancer?
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about 50y/o
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Advanced CIN arising in the squamous epithelium of the cervical transformation zone often progress to what?
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invasive squamous cell cervical carcinoma
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WHat are some other etiologies (besides HPV) that are associated with cervical carcinoma?
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-factors related to the male ejaculate
-the immature transformation zone, - the number of different -sexual partners, -cigarette smoking |
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What are 3 rare types of cervical cancer that is encountered?
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-clear cell carcinoma
-associated with diethylstilbestrol (DES) in utero -sarcoma and lymphoma |
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Survival rates for cervical cancer reflects what?
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the extent of disease at the time of dx
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No classic historical presentation exists for what?
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cervical cancer
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What 2 symptoms are often associated with cervical carcinoma?
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1-postcoital bleeding
2-abnormal uterine bleeding |
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What should be done to visible lesions located on the cervix?
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biopsy
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What lesions should be considered for immediate biopsy?
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-new exophytic, friable, or bleeding lesions
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Cervical carcinmoa tends to spread how?
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in a predictable manner by direct invasion and by lymphatic metastasis
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FIGO staging is based on what?
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clinical evaluation
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What are the mainstays of tx for invasive cervical carcinoma?
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-radical surgical therapy
-pelvic irradiation |
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In general, surgical tx for cervical carcinoma is for what patients?
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those with stage 1 and select stage 2
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Radical surgical thearpy includes what?
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radical hysterectomy aimed at removing all the central disease
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What is also an important part of radical surgical therapy?
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surgical eradication of the local and regional lymph nodes
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What is an inadequate tx for invasive cervical carcinoma?
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simple hysterectomy with removal of the cervix
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Stage IA1 cancer pts are the only people who can be treated with what?
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simple hysterectomy
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Stage IA1 with lymphovascular space invasion up to patients with stage IB1 disease may be considered for for what?
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radical trachelectomy or radical hysterectomy
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Radiation therapy for cervical cancer is usually reserved for which patients?
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thos with stage IB or IIA who are poor surgical candidates and for all pts whi more advanced disease
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Radiation therpy is now give concurrently with what?
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either cisplatin or cisplatin with 5 Fluorouracil chemotherapy
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What type of radiation is used in most patients?
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High dose external beam therapy and intracavitary irradiation
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What does LSIL stand for?
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cells from lesions that are HPV associated, mild dysplasia or CIN I
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What does HSIL mean?
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cells from lesions that are moderate to severe dysplasia, CIN II or III or carcinoma in situ
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What is the diagnostic process for LSIL?
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colposcopy with directed biopsy
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What is the dx process for HSIL?
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colposcopy, biopsy, conization, endocervical sampling and sometimes endometrial sampling
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After an abnormal pap, endometrial biopsy should be done with colposcopy if the patient is what?
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over 35 or if younger and unexplained bleeding
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Lesions usually appear with relatively discrete borders near where?
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SCJ
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What is the first reason for conization?
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unsatisfactory colposcopy
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What is the 2nd reason for conization?
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positive ECC
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What is the 3rd reason for conization?
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substantial discrepancy between Pap and biopsy results
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When is cold knife conization more appropriate?
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for glandular abnormalities
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If margins are positive for high-grade epithelial lesions or carcinoma in situ, what is the best therapy?
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hysterectomy
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Colposcopically directed laser thearpy can be used to ablate what lesions?
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CIN lesions
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