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40 Cards in this Set
- Front
- Back
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what are the risk factors for cervical cancer?
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1) young age at first coitus (<20)
2) multiple sexual partners 3) sexual partner w/ multiple sexual partners 4) young age at 1st pregnancy 5) High parity 6) smoking, lower socioeconomic status 7) immunosuppression- AIDs defining illness |
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What are the high risk types of HPV? low risk types? what do they cause?
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high: 16, 18- cervical cancer
low: 6 and 11- genital warts and anal cancer |
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22 year old female presents to your office HPV positive, do you think this will be a transient or a persistent strand of HPV?
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transient- in teens and early 20s, think transient
in 30s think- persistence. |
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what is the Gardasil vaccine?
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quadrivalent vaccine w/ HPV strands 6,11, 16, and 18
given to females and males ages 9-26 via IM injection at 0, 2 and 6 months. Most effective if given before onset of sexual activity. |
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when should someone start receiving a pap smear? what are the intervals that they should get them? what are the stipulations with the intervals?
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start at age 21
interval: every 2 years from 21-29 every 2-3 years over 30 IF -3 consecutive negative paps - no HIV or immunosuppression -no CIN2 or CIN 3 -no DES exposure |
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when can you discontinue giving a pt pap smears?
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-hysterectomy for non-cancer reason
-age 65-70 and low risk and 3 negative pap smears in the last 10 years |
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what is the number 1 cause of vaginal cancer?
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previous endometrial cancer
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what type of medium is used for pap smears?
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thin prep- liquid based medium--> less ASCUS allows for HPV test w/ a sensitivity of 80%
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_____ of women diagnosed with cervical cancer every year never had cytology testing
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50%
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what are the 7 bethesda classifications of epithelial cell abnormalities?
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ASCUS – Atypical squamous cells of undetermined significance
LSIL – low grade squamous intraepithelial lesion (LGSIL) HSIL – high grade squamous intraepithelial lesion (HGSIL) Squamous Cell CA AGC – atypical glandular cells Endocervical adenocarcinoma in situ Adenocarcinoma |
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when would you do an HPV reflex test?
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If a pt comes back w/ ASCUS or above on cytology.
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what is colposcopy? what is the purpose of it?
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Binocular microscope add 3-5% acetic acid to burn off any mucus or debris. This will allow you to evaluate surface epithelium and subepithelial blood vessels. It will identify transformation zone and you can biopsy suspicious lesions.
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what is CIN 1? 2? 3?
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CIN1- mild dysplasia- low grade intrathelial lesions will regress on own 60% of time
CIN2- moderate dysplasia- high grade intrathelial lesions CIN3- severe dysplasia- less likely to regress on own. |
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what ablative procedures would you use in CIN 1? what other ablative procedure is available?
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cryoptherapy- requires no diagnosis, no anesthesia and the pt will have vaginal discharge after.
laser- destroys transformation zone by carbon dioxide laser, no diagnoses but requires local anesthesia. |
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what are the two types of excisional procedures? which one is more useful? which one is more dangerous?
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1) loop electrosurgical excision procedure (LEEP)- gets tissue -- a little less useful because you are destroying the margin histology. Requires local anesthesia.
2) conization (laser or cold knife)- diagnosis, general anesthesia and can cause cervical stenosis and cervical inncompetence which increases infertility. --> more dangerous. |
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what are the 5 indications for a diagnostic cone biopsy?
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Unsatisfactory colposcopy
Endocervical curetting show a high grade lesion Pap smear shows high grade lesion not confirmed by biopsy Pap smear indicate adenocarcinoma in situ Microinvasion is present on biopsy |
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Vaginal bleeding tends to be a ____ sign in cervical cancer, but an ____ sign in endometrial.
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late
early |
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what are the signs and sxs of cervical cancer?
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Abnormal vaginal bleeding
Postcoital bleeding Vaginal discharge Pelvic pain Leg swelling Urinary frequency Fistula formation – loss of urine or stool from the vagina- late sign |
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35 year old female presents w/ weight loss, enlarged LN, ascites and post-coital bleeding. What would you expect to find on a pelvic exam?
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ulcerative and necrotic tissue. A friable (breaks off easily and bleeds) cervix.
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what 2 exams would you do in a physical exam of a pt presenting with the signs and symptoms of cervical cancer?
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Pelvic and rectovaginal exam.
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what are the three patterns of spread of cervical cancer?
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1) direct invasion (cervical stroma, uterine corpus, vagina, parametrium)
2) lymphatic spread (pelvic--> paraaortic lymph nodes) 3) Hematogenous spread (lung, liver, bones) |
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what is the single most important prognostic factor of cervical cancer?
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Paraaortic LN status
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what are the tx options for cervical cancer?
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surgery
radiation therapy: extrenal beam, brachytherapy (intracavitary, interstitial) |
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what is a simple total hysterectomy?
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uterine corpus and cervix removed
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what is a subtotal hysterectomy?
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removal of uterine corpus at level of internal cervical os
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what is a bilateral salpingo-oophorectomy surgery?
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Removal of the ovaries and all attached appendages.
TAH-BSO: total abdominal hysterectomy- b/l salpingo-oophorectomy. |
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57 year old female presents with an itch downstairs. You do a pelvic exam and find a palpable lesion. How would diagnose and tx this ailment?
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Dx: vulvar intraepithelial neoplasia
diagnosis via visual insepction, colposcopy w/ 5% acetic acid and biopsy. tx: surgical exision and vulvectomy. |
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what is bowenoid papulosis? how do you tx?
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affects the younger population. Has multiple reddish brown or violaceous papules.
tx: local excision and laser therapy. |
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What is difference between bowenoid papulosis and VIN III histologically?
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NADA! nothin!
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65 year old white female presents w/ itchiness and tenderness of the nipples. Upon examination you notice that her nipples have quite a bit of eczema. What is this dz usually associated w/? tx?
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Paget's dz is usually associated w/ adenocarcinoma.
Tx: local excision or laser therapy. |
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what type of cell is most common in invasive valvular carcinoma?
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Squamous cell
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what is the most common site of valvular cancer? what is the most common clinical feature of valvular cancer?
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Labia majora; pruritis
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what is the most common spread of valvular cancer?
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direct extension- vagina, urethra, anus
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what are the 5 ways you can manage valvular cancer?
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1) radical local excision
2) radical vulvectomy 3) groin dissection 4) preoperative radiation or chemotherapy 5) postoperative radiation |
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what is the survival rate of valvular cancer?
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overall-70%
positive nodes- 5 year survival- 50% negative nodes - 5 year survival 90% |
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what part of the vagina is usually involved in vaginal cancer? what increases your risk of vaginal cancer? how do you tx it?
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upper third of vagina
increased risk w/ previous cervical or valvular carcinoma tx: surgical excision |
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what is the mean age of squamous cell cancer of vagina? sxs?
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60 years of age
sxs: abnormal vaginal bleeding, vaginal discharge and urinary sxs |
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a 60 year old female presents to your office complaining of post menopausal bleeding and difficulting urinating. On physical exam you feel an ulcerative and infiltrative growth. Dx and tx
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Squamous cell cancer of Vagina
tx: surgery is limited (but if nodal involvement- consider surgical removal), so you can use radiotherapy. |
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what is the prognosis of squamous cell cancer of the vagina?
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5 year- 50%
stage 1 lesions- 85-95% stage 4 lesions- 5-10% |
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What causes clear cell adenocarcinoma? what is the mean age? how do you tx it? overall survival?
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DES exposure in utero ( so mom taking DES causes daughter to have clear cell adenocarcinoma)
- mean age 19 tx: radical hysterectomy and vaginectomy -overall 5 year survival- 80% |
