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NURP 501 - Ex 1 > 3: Cervical Cancer > Flashcards

3: Cervical Cancer Flashcards

1
Q

T/F Human papillomaviruses are small, non-enveloped viruses containing 72 capsomeres coating a genome of double-stranded circular DNA

A

True

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2
Q

Why does COC use increase cervical cancer risk?

A

While the connection between COCs and cervical cancer is not yet fully understood, it appears that the estrogenic effect of COCs may prevent the ectopy of the cervix from receding into the cervical canal, leaving the vulnerable area exposed. Moreover, COC users are less likely to use barrier protection, thereby increasing their risk of contracting HPV.

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3
Q

HPV is the most common, symptomatic _____ STI in the US. Up to 80% of sexually active women are infected with HPV.

A

HPV is the most common, symptomatic viral STI in the US. Up to 80% of sexually active women are infected with HPV.

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4
Q

Normally, the type of cells that cover the vagina and the portico vaginalis of the cervix.

A

Squamous epithelium

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5
Q

This contraceptive imparts a lower risk of cervical cancer.

A

IUDs

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6
Q

When is the greatest risk for cervical cancer (not HPV infection)?

A

Midlife

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7
Q

What is the follow up for high-grade lesions (CIN2 or 3)?

A
  1. Cryotherapy
  2. Laser ablation
  3. Loop excision
  4. Cold knife conization

Early-stage cervical cancer may be treated with:

  • hysterectomy

or

  • chemoradiation
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8
Q

Which strain of HPV is the most common one associated with adenocarcinoma?

A

16 followed by 18

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9
Q

Which system is most commonly used to report Pap screening results?

A

Most laboratories in the United States use the Bethesda System for reporting the results of cervical cytology. Satisfactory specimens require at least 5,000 squamous cells for a liquid-based preparation, with a minimum of 10 endocervical or squamous metaplastic cells. Unsatisfactory specimens include those in which more than 75% of the epithelial cells are obscured, which may occur due to inflammation or blood. The Bethesda System includes the general categories of “negative for intraepithelial lesion or malignancy,” “epithelial cell abnormality,” or “other,” which may describe an unusual finding such as endometrial cells that might require further investigation. If there is an unusual or abnormal finding, the goal is to either document or rule out high-grade disease (CIN 3 or HSIL).

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10
Q

_____ of high-grade preinvasive cervical lesions NOT covered by HPV vaccine.

A

1/3 of high-grade preinvasive cervical lesions NOT covered by HPV vaccine.

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11
Q

What are the starting and ending ages for the HPV vaccine in men and women?

A
  • Women:
    • as young as 9, but recommended 11-12.
    • Ends at 26.
  • Men:
    • as young as 9, but recommended 11-12.
    • Ends at 21.
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12
Q

What is follow up for cervical intraepithelial neoplasia 1 (CIN1)?

A

Two choices:

  1. Follow until evidence of CIN 2 or 3, or CIN1 x 2 years or more, then colposcopy.
  2. Cytology alone @ 6mo and 12mo or HPV-DNA testing @ 12mo - OR - colposcopy + cytology @ 12mo.
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13
Q

Brand name for HPV vaccine: 2 4 9

A
  1. 2 = Cervarix
  2. 4 = Gardasil
  3. 9 = Gardasil 9
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14
Q

If these situations happened, when would you rescreen? Cervix can’t be visualized Endocervical canal cannot be sampled Glandular abnormality Abnormal cytology did not receive adequate follow-up HPV-DNA test within past year turned positive Previous screening was insufficient

A

6 months

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15
Q

What is a hallmark of malignant transformation?

A

Integration of the viral genome into the host cell genome.

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16
Q

What 3 things can cause an unsatisfactory cervical sample?

A
  1. Inadequate sampling
  2. Air drying
  3. Excessive RBCs or WBCs (not as important for liquid-based medium)
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17
Q

Contraindications for HPV vaccines.

A
  1. All: Pregnancy (can be given in breastfeeding)
  2. 4/9: Yeast sensitivity
  3. 2: Latex hypersensitivity (give out of vial not prefilled needle)
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18
Q

Premalignant changes can represent a spectrum of cervical abnormalities, which are referred to as _____ or _____.

A

Premalignant changes can represent a spectrum of cervical abnormalities, which are referred to as squamous intraepithelial lesions (SIL) or cervical intraepithelial neoplasia (CIN).

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19
Q

Where do squamous cell cancers and their precursors virtually always develop?

A

Transformation zone of cervix (squamocolumnar junction).

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20
Q

Normally, the type of cells that cover the endometrial canal and in younger women, the area around the external cervical os.

A

Columnar epithelium

21
Q

What is an oncogenic cofactor for cervical cancer?

A

Smoking

22
Q

What is the major difference between low-risk and high-risk HPV types?

A

The major difference between low- and high-risk HPV types is that after infection is established, the low-risk HPV types are maintained as extra-chromosomal DNA episomes, while the high-risk HPV genomes become integrated into the host cells’ DNA in malignant lesions.

23
Q

When 3 conditions should be met for a repeat Pap?

A
  1. Midcycle
  2. No vaginal products at least 24 hours
  3. >6 weeks after first attempt
24
Q

False negatives occur 20% of the time in screening. What 3 things could cause them?

A
  1. Too few cell from lesions
  2. Sampling error
  3. Interpretive error
25
Q

Common sites for distant metastasis of cervical cancer.

A
  1. Pelvic lymph nodes
  2. Liver
  3. Lungs
  4. Bones
26
Q

T/F The risk of cervical cancer triples with combined oral contraceptive (COC) use, but returns to normal about 10 years following discontinuation of oral contraceptives.

A

False. The risk of cervical cancer doubles after 5 years of combined oral contraceptive (COC) use, but returns to normal about 10 years following discontinuation of oral contraceptives

27
Q

Name 4 glandular cell abnormalities.

A
  1. Atypical Glandular Cells (AGC) – uncommon but potentially dangerous (associated with high-grade lesions)
  2. Atypical glandular cells, favor neoplastic – suggestive but not sufficient for interpretation of adenocarcinoma
  3. Endocervical adenocarcinoma in situ (AIS)
  4. Adenocarcinoma
28
Q

What concerns exist in giving the HPV vaccine to immunocompromised patients?

A

It can be given, but there may be a decreased immune response.

29
Q

T/F first-time pregnancies that occur in women younger than 17 years are associated with twice the risk of cervical cancer compared to women who develop cervical cancer later in life.

A

True

30
Q

Which strain of HPV is the most common one associated with squamous cell carcinoma?

A

16

31
Q

When are columnar cells around the cervical os relaced by squamous?

A

Menarche

32
Q

T/F Cervical cancer is the most common gynecological malignancy during pregnancy.

A

True

33
Q

When would HPV reflex DNA testing be performed?

A
  1. After abnormal result (ACS-US)
  2. Simultaneously with Pap for those 30+
34
Q

Which strains of HPV cause 70% of CIN2 and 3 lesions?

A
  1. 16
  2. 18
35
Q

What are the 2 main types of cervical cancer?

A
  1. Squamous cell carcinoma (SCC) (80-90%)
  2. Adenocarcinoma (10-12%)
36
Q

Where does squamous cell carcinoma usually arise?

A

Squamous cells that cover the ectocervix

37
Q

T/F 2nd hand smoke is associated with an increased risk of cervical cancer.

A

True. Lower risk than active smoking, but a risk nonetheless.

38
Q

In the HPV vaccine, what causes immunity?

A

Envelope proteins (virus-like particles) stimulate anti-HPV antibodies.

39
Q

Which strains of HPV cause 90-100% of genital warts and low grade lesions without malignant potential?

A
  1. 6
  2. 11
40
Q

Name the 3 regions of the HPV genome.

A
  1. An early (E) region that codes for cellular transformation.
  2. A late (L) region that codes for the structural proteins L1 and L2, which are responsible for creating the capsid.
  3. A long control region that determines replication and gene function.
41
Q

Cell wise, why are young women more vulnerable to HPV infection (and therefore cervical cancer)?

A

Younger women have immature metaplastic cells.

42
Q

Screenings prevent at least _____% of potential cervical cancers.

A

Screenings prevent at least 70% of potential cervical cancers.

43
Q

These are caused by DNA mutations in immature metaplastic cells d/t HPV infection.

A

Preinvasive cervical lesions

44
Q

Where does adenocarcinoma usually arise?

A

Columnar epithelium (a group of mucus-producing glandular cells) located in the endocervix

45
Q

What is the most significant risk factor for cervical cancer?

A

Persistent infection with high-risk HPV. The high-risk HPV types include 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73, and 82.

46
Q

Which vaccines are for men and women?

A
  1. Women: 2/4/9
  2. Men: 4/9
47
Q

Risk factors for cervical cancer.

A
  1. COC use of 5+ years.
  2. Immunosuppression (esp HIV)
  3. Smoking
  4. Multiple sex partners
  5. Early age at first intercourse
  6. High parity (3+ full-term)
  7. Genetic predisposition
  8. Diets low in fruit and vegetables
  9. Low levels of vitamins C and E, folate, and carotenoids
  10. Poverty
  11. Women exposed to DES in utero (clear cell carcinoma)
  12. HSV-2 and chlamydia infections
48
Q

Which types of premalignant changes are more likely to spontaneously regress vs persist or progress?

A

CIN 1 often regresses spontaneously, whereas CIN 2 and 3 are more likely to persist or progress.

NURP 501 - Ex 1 (63 decks)

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