Cervical and uterine Flashcards
(73 cards)
1
Q
What is the transformation zone in the cervix
A
- lies between exocervix and endocervical canal
- squamo-columnar junction
- metaplastic squamous epithelium
2
Q
HPV 16 has a higher frequency of what type of cervical cancer
A
squamous cell carcinoma
3
Q
HPV 18 has a higher frequency of what type of cervical cancer
A
adenocarcinoma
4
Q
list the high risk and low risk strains of HPV
A
- high risk: 16, 18
- low risk: 6, 11
5
Q
risk factors for HPV infection
A
multiple sex partners
6
Q
What is the best screening test for cervical cancer
A
- HPV DNA testing
7
Q
when is screening for cervical cancer initiated
A
- screen women starting at the age of 21 despite the age of sexual debut
- this recommendation does not apply to high-risk populations (immunocompromised)
8
Q
what cervical cancer screening is done for women aged 21-29
A
- cytology performance only q 3 years
- DO NOT perfomr HPV DNA testing
9
Q
what cervical cancer screening is done for women aged 30-64
A
- cytology + HPV DNA testing q 5 years or
- cytology alone q 3 years
10
Q
who are the patients at high-risk for developing cervical cancer who need yearly screening
A
- HIV positive women
- immunocompromised
- personal hx of cervical cancer
- hx of CIN II/III
- exposure to DES in utero
11
Q
When performing speculum examination and an abnormal cervical lesion is noted, perform what
A
-
biopsy
- not a pap smear
- a pap smear is a screening tool
- biopsy is diagnostic
- not a pap smear
12
Q
follow up for women aged 21-24 who have atypical cells of undetermined significance (ASC-US)
A
- repeat pap smear in 1 year regardless of HPV result
13
Q
follow up for women aged 24-64 who have atypical cells of undetermined significance (ASC-US)
A
-
must reflex to HPV DNA
- negative HPV DNA = normal cytology
- repeat pap smear/co-testing in 3 years
- positive HPV DNA -> refer for colposcopy
- negative HPV DNA = normal cytology
14
Q
follow up for women aged 21-24 who have Low-grade squamous intraepithelial lesions (LSIL)
A
- repeat pap smear in 1 year regardless of HPV result
15
Q
follow up for women aged 24-64 who have Low-grade squamous intraepithelial lesions (LSIL)
A
- refer for colposcopy despite HPV result or
- repeat Pap smear/co-testing in 1 yr if HPV DNA testing is negative
16
Q
Low-grade squamous intraepithelial lesions (LSIL) are usually consistent with
A
- Cervical intraepithelial neoplasia I
17
Q
follow up if “High-grade squamous intraepithelial lesion” (HSIL) is present
A
- assume HPV DNA is present
- refer for colposcopy (all ages)
18
Q
“High-grade squamous intraepithelial lesion” (HSIL) are usually consistent with
A
- CIN II-III
19
Q
followup for ages 21-29 with negative cytology, no endocervical cells
A
- routine screening - repeat Pap in 3 years
- DO NO perform HPV DNA testing
20
Q
followup for ages > or = 30 with negative cytology, no endocervical cells
A
- perform HPV DNA testing
- negative: repeat pap in 5 years
- positive:
- refer for colposcopy if HPV 16/18 or
- repeat cytology and HPV in 12 months
21
Q
differenatiate between cervical intraepithelial neoplasia I, II, and III
A
- I: involves lower third of epithelial lining
- II: involves lower two-thirds of epithelial lining
- III: involves more than two-thirds of epithial lining
22
Q
What are the two types of cervical cancer
A
- cervical squamous cell cancer
- cervical adenocarcinoma
23
Q
which HPV strains are most associated for cervical cancer
A
- HPV 16, 18
24
Q
clinical presentation
- frequently asymptomatic
-
abnormal vaginal bleeding
- most common
- postcoital bleeding
- pelvic pain, unilateral with radiation into hip or thigh
- vaginal discharge
A
- cervical cancer
25
uterine fibroids arise from
smooth muscle cells within the uterine wall
26
where are submucosal uterine fibroids located
* lie just beneath the endometrium
27
where are subserosal uterine fibroids located
* lie just at the serosal surface of the uterus
28
where are intramural uterine fibroids located
* lie within the uterine wall
29
clinical presentation
* abnormal uterine bleeding
* pain
* pelvic pressure
* infertility
* spontaneous abortion
uterine fibroids
30
MOA of Depot Lupron
* GnRH agonist that will decrease uterine fibroid size
* not approved for use over 6 months
31
steroidal therapies are indicated for what types of uterine fibroids
* patients with prolonged, heavy menses with **no submucosal fibroids**
32
what steroidal therapies are used in tx of uterine fibroids
* OCP
* mirena IUD
* ortho evra
* nuva ring
33
MOA of Lysteda
* tranexamic acid
* oral antifibrinolytic for menorrhagia
* use only during menstrual cycle
34
Lysteda is indicated for tx of what symptoms/types of uterine fibroids
* indicated for patients with prolonged, heavy menses with **no submucosal fibroids**
* used only during menstrual cycle
35
Myomectomy is perfomed on what uterine fibroids
* intramural, subserosal, and pedunculated fibroids
36
function of Myomectomy
* surgical treatment of uterine fibroid that **preserves fertility/uterus**
37
When is abdominal or Minilaparatomy Myomectomy used
* pts with contraindications to laparoscopy
* fibroid size does not permit laparoscopic approach
* prior pelvic or abd radiation therapy
* severe hip disease
* inadequate renal or hepatic function
38
hysteroscopy is performed on what type of uterine fibroids? what is its function
* only performed on **submucosal fibroids**
* uses a heated loop to resect fibroid; **preserves fertility/uterus**
39
When is endometrial ablation used in surgical tx of uterine fibroids? what does it preserve?
* tx of menorrhagia
* preserves utuerus
* childbearing rare after procedure
40
What does uterine artery embolization preserve
* **preserves uterus**
* not fertility
41
contraindications for uterine artery embolization
* numerous and large fibroids
42
What is adenomyosis
* growth of endometrial glands and stroma into uterine myometrium
43
clinical presentation
* menorrhagia
* dysmenorrhea
* pelvic pain
* h/x of previous uterine surgery
* c-section
* prior myomectomy
adenomyosis
44
how is adenomyosis diagnosed
* bimanual exam reveals diffuse uterine enlargement
* definitive daignosis requires histologic examination after hysterectomy
45
medical options for treatment of adenomyosis
* improve dysmenorrhea and menorrhagia
* OCP
* mirena IUD
* nuva ring
46
surgical options for adenomyosis
* hysterectomy: definitive
* uterine artery emboliziation
* endometrial ablation
47
define endometriosis
* presence of endometrial glands and stroma outside of teh endometrial cavity and uterine musculature
* usually in pelvis but can be elsewhere
48
clinical presentation
* premenstrual pelvic pain
* **pain subsides after menses**
* infertility
* dysmenorrhea
* dysparenunia
* elevated CA-125
* endometriosis
* lesion growth stimulated by estrogen and progesterone
49
what physical exam findings are consistent with endometriosis
* tenderness at posterior cul-de-sac
* fixed or retroverted uterus (secondary to adhesions)
50
how is endometriosis diagnosed
* laparoscopy
* erythematous, petechial lesions on peritoneal surface
* surrounding peritoneum thickened and scarred
51
most common site of endometriosis
* ovaries
* "chocholate cysts"
52
treatment of mild endometriosis
* NSAIDS
53
treatment of moderate-severe endometriosis
* goal: interrupt stimulation of endometrial tissue
* OCP
* Progestins (depo provera, mirena IUD)
* Depot lupron
* Laparoscopy with excision
* hysterectomy
54
risk factors for endometrial hyperplasia
* **obesity**
55
what stimulates endometrial hyperplasia
* **unopposed estrogen** leads to endometrial hyperplasia
* estrogen stimulates proliferation of endometrium
* progesterone has antiproliferative effects causing shredding of lining
56
clinical presentation
* asymptomatic
* post-menopausal bleeding
* menorrhagia
* intermenstrual bleeding
* prolonged menses (\> 7 d)
* descreased menstrual interval (\< 21 d)
* oligomenorrhea/amenorrhea
endometrial hyperplasia
57
how is endometrial hyperplasia diagnosed
* pelvic ultrasound
* assess endometrial thickness
* endometrial biopsy
* D&C hysteroscopy
58
treatment of endometrial hyperplasia without atypia
1. Mirena IUD
2. provera 10 mg qd for 3-6 months
3. reassess with endometrial biopsy to ensure resolution
59
treatment of endometrial hyperplasia with atypia
* **hysterectomy** is treatment of choice
* progesterone therapy
60
what is the most common gynecologic cancer
endometrial cancer
61
risk factor for endometrial cancer
obesity
62
primary causative factor of endometrial cancer
* estrogen
* progression from endometrial hyperplasia
63
endometrial cancer type I
* arise due to unopposed endogenous or exogenous estrogen
64
endometrial cancer type II
* arise independently of estrogen and seen with endometrial atrophy
* poor prognosis
65
what is the most common type of endometrial cancer
* adenocarcinoma
66
List the four endometrial cancer classifications
1. adenocarcinoma
2. adenocarcinoma with squamous differentiation
3. serous carcinoma
4. clear cell carcinoma
67
which two types of endometrial cancer are not associated with hyperestrogenic state
* serous carcinoma
* clear cell carcinoma
68
clinical presentation
* abnormal vaginal bleeding
* abd cramping
* back pain
* weight loss
* dyspareunia
endometrial cancer
69
what screening for endometrial cancer is recommended in women with lynch syndrome (aka HNPCC)
Colaris testing
70
what lab value is elevated in 20% of stage I pts with endometrial cancer
CA-125
71
treatment of endometrial cancer
* **hysterectomy** with bilaterally salpingoophorectomy with pelvic and peraortic lymphadenectomy
* radiation used in pts with contraindications to surgery
* chemotherapy used infrequently
72
next step for '' unsatisfactory" cytology result in a woman \< 30
repeat PAP in 2-4 months
73
next step for '' unsatisfactory" cytology result in a woman \> 30
* obtain **HPV DNA test**
* **negative**: repeat pap in 2-4 months
* **positive**
* refer for colposcopy or
* repeat cytology in 2-4 months
