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71 Cards in this Set
- Front
- Back
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What are the risk factors for cervical cancer?
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"SHH, PINC"
>2 - sexual partners >3 - years since last pap <20 - when first intercourse Smoking STIs HPV/ HSV High risk male partners Previous abnormal pap or bx (CIN) Immunosuppression Nutritional deficiencies Conception at a young age |
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what is the MC STI?
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HPV
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what strains of HPV are found in 95% of cervical cancers?
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16 and 18
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HPV ___ is the MC oncogenic type and causes most cervical squamous cancer
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16
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HPV ___ is the most prevalent high-risk type in cervical adenocarcinoma
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HPV 18
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is intercourse necessary for the spreading of HPV?
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no! just genital contact
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the cdc estimates how many women will have HPV by age 50?
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80%
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HPV 16 and 18 cause ___% of all cervical cancers
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75%
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sign and sx of cervical cancer include?
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post coital bleeding
abnormal bleeding pain |
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why is it important to detect and treat pre-invasive cervical disease?
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can prevent progression to invasive cancer
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____ programs have shown significant decrease in mortality from cervical cancer
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regular cervical cancer screening programs
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The pap smear was named after who?
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Dr. George Papanicolaou
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what is the point of the PAP
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to catch pre-invasive disease since this is usually curative and prevents deveopment of invasive disease
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transition from CIN 1 or 2 or 3 can take how long to turn into invasive cancer?
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1-7 years
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most cervical cancer is what kind?
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squamous cell (80%)
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HPV is a causative agent for what cancer?
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cervical
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When do we start screening women with pap smears?
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At 21 yo
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from 21-29 yo how often do we perform a pap? HPV testing?
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once every 3 years with pap only
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for women 30-65 how often do we perform a pap? HPV testing?
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pap every 3 years
or do pap with HPV every 5 years |
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For women older than what age do we no longer screen for cervical cancer?
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>65 with evidence of adequate prior screening we no longer screen
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Do we pap or HPV test after a hysterectomy?
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no
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If a women has had the HPV vaccine do we still need to do a HPV test? If so at what age?
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yes, still need to screen, not necessarily for HPV though, can do regular pap
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the USPSTF guidline are for the general population. They do not include standards for women with what factors?
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1. hx of cervical cancer
2. exposed to DES 3. immune-compromised (HIV) |
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what is the site of most squamous pre-invasive and invasive neoplasms?
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Cervical transformation zone (TZ) squamoclumnar junction
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metaplastic changes of the cervix are most active when?
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during adolescence and pregnancy when elevated estrogen levels may be stimulus
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by products of cigarette smoke are concentrated where? and have been associated with what?
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concentrated in cervical mucus and associated with depletion of macrophages that assist in cell-mediated immunity in the TZ
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what are 3 benign changes in the cervix?
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1. nabothian cysts
2. cervical polyps 3. ectropion |
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sequence in a pap smear is critical. describe:
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Do the pap before bimanual pelvic and before taking samples for cultures
1. wooden/plastic Ayre, 360 degrees 2. cytobrush 360 degrees only use water on speculum spread samples thinly and uniformly on glass slide |
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what are 4 common causes of false-negatives on pap smear
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1. sampling error - provider doesn't get the right cells
2. Screening error - cytopathologis doesnt find abnormal cells 3. Diagnostic error - cytopathologist fails to properly interpret abnormal cells 4. lab errors - cells not collected on proper device, not transferred right, poorly preserved |
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__________ --> CIN --> ___________
CIN classification |
atypical transformation zone --> CIN --> pre-invasive cervical cancer
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moderate dysplasia, what CIN?
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CIN II
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CIN III means?
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severe dysplasia and carcinoma in situ
20% go on to microinvasive cancer and then to invasive cancer |
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what percent of Carcinoma in situ go on to micro invasive cancer to invasive cancer?
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20%
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what advantages over previous methods of reporting does the Bethesda system provide?
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1. clearly separates benign changes caused by reactive or inflammatory processes from true epithelia abnormalities.
2. replaced CIN with SIL 3. Includes HPV effect in LSIL category |
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what reporting system? Abnormal cells reported as either low or high grade SIL (squamous intraepithelial lesion)
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Bethesda
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What is the format of the Bethesda Report?
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1. specimen type
2. specimen adequacy 3. general categorization 4. Automated review 5. Ancillary testing 6. interpretation/results |
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what is performed in conjunction with colposcopy to r/o dysplasia within the canal that is coposcopically unapparent?
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endocervical canal curretage (ECC)
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a photo of cervix taken after acetic acid aplied . highly sensitive with few false negatives, more expensive than pap
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cervicography
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what does the HPV DNA test offer that the pap doesn't?
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more sensitive for HSIL (high grade squamous intraepethilial lesion). recommended for women over 30
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what two computerized automatic pap smear screening tests use neural network technology to recognize and photograph abnormal cells?
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PapNet, AutoPAP
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All women with a smear that is not normal should undergo what?
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Colposcopically directed bx and ECC before tx options are considered***
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___ may be necessary if results of colposcopy are eqivocal
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conization
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If results from colposcopy are determinant no need to do conization, how would you proceed with tx?
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cryotherapy, laser, LEEP are the treatment options
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Mild dysplasia, CIN 1, CIN II and CIN III have potential for progression to invasive cervical cancer in up to 33% of women within how long?
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2-15 years if left untreated
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Cure rates for one treatment range?
FOr repeat tx of the adequately evaluated persistent lesion affects cure rate of? |
85-96%
95% |
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Post treatment for cervical cancer, what is the risk of lesions persisting or recurring ?
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5-15%
do another pap smea 3 months after and then every 6 months and then annual colposcopy for 2 years |
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define microinvasive carcinoma of the cervix:
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depth of invasion less than 3mm with NO lymphovascular space involvement and not confluent tongues of tissues
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what is the tx of choice for microinvasive carcinoma of the cervix?
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total abdominal hysterectomy - cure rate 95%
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What are the MC sx of invasive carcinoma of the cervix?
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postcoital or irregular bleeding
also malodorous, bloody discharge and deep pelvic pain |
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invasive cervical carcinoma is most likely what type?
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squamous carcinoma 85%, adenocarcinoma 13%
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treatment for invasive carcinoma of the cervix depends on patients age, general health, and clinical stage of cancer. The primary modalities include?
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surgery and RT
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Approx ____ of patients with invasive cervical cancer have persistent or recurrent disease
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35%
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Most common pelvic genital cancer in women?
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endometrial carcinoma
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MC sx of endometrial carcinoma?
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irregular menses and post menopausal bleeding
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what are the risks for endometrial carcinoma?
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1. obesity
2. chronic anovulation/PCOD, nulliparity 3. granulosa-theca cell ovarian tumors 4. exogenous unopposed estrogen 5. Endometrial hyperplasia 6. late menopause 7. tamoxifen 9 breast or ovarian cancer |
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____ is thought to be the precursor to endometrial carcinoma
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endometrial hyperplasia
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the risk of endometrial hyperplasia progressing to endometrial carcinoma is?
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1-14% in untreated cases
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the risk for endometrial hyperplasia is greatest in?
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postmenopausal women and in women with atypical adenomatous hyperplasia
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what is the 5th leading cause of cancer death in women in the US?
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ovarian cancer
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when does the incidence of ovarian cancer begin to rise?
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5th decade to 8th
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The ____ patient is at high risk for developing ovarian cancer
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post menopausal
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_______ cancer is silent in its early development
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ovarian cancer
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what is the serodiagnostic screening test for dx ovarian cancer?
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there is no dependable one
the CA 125 antigen level CANNOT serve as a screening test |
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what is the MC type of ovarian cancer?
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serous cystadenoma - epithelial tumor
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What is Meig's syndrome?
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ascites, hydrothorax and ovarian fibromas
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what is the biggest risk factor for ovarian cancer?
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family hx
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What are 7 steps to the dx of ovarian cancer?
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1. Signs and sx - focus on sx frequency, severity and duration (pelvic mass, abd.distention, pain, weight loss)
2. Early detection depends on periodic pelvic exams after 40 3. CA -125 high in 85% of patients with ovarian cancer but not for screening good for monitoring 4. B-HcG, Alpha fetoprotiein, LDH - good tumor markers for germ cell malignancies seen in younger women 5. Abdominopelvic CT scan, barium enema, CXR, evaluate extent of disease 6. Pelvic US useful in detecting 95% of cancers greater than 5cm. multicycstic and free fluid in cul-de -sac are suggestive 7. surgical staging |
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What are the 6 surgical staging evaluations for ovarian cancer?
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1. exploratory laparotomy
2. Peritoneal washings from pelvic and upper abdomen 3. inspect peritoneum and diaphragmatic structures 4. sampling of pelvic and para-aortic lymph nodes 5. sampling of omentum 6. Wedge biopsy of contralateral ovary to exlude occult disease |
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what type of cancer is vaginal cancer?
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squamous cell
its a rare cancer |
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what are the sx of vaginal cancer
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1. vaginal discharge = MC, usually bloody
2. urinary sx |
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what are the sx of vulvar carcinoma?
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1. often delay in dx because of either self tx by patient or lack of recognition by provider
2. vulvar cancer presents with: a. hx of chronic vulvar irritation or soreness b. visible lesion on labia which is often sore beware of the lesion that doesn't heal |
