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Obstetrics And Gynecology > Cervical Cancer > Flashcards

Cervical Cancer Flashcards

(60 cards)

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1
Q

M/C cancer in women in India

A

Ca breast > Ca cervix

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2
Q

M/C genital cancer of women in India

A

Ca cervix

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3
Q

Most common cause of Ca Cervix

A

HPV - 99%

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4
Q

Screening method used for Ca cervix

A

Pap smear

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5
Q

Pap smear is taken from which area and Procedure

A

Done at transformation zone (area b/w endocervix and ectocervix) - then plate them on slide - fixed with 95% alcohol - solution passed through filter - Cells from transformational zone gets filtered

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6
Q

Instrument used for Pap smear

A

Ayre’s spatula
Also cytobrush and Cytobroom can be used - Liquid based Cytology

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7
Q

Sensitivity of Pap smear as screening method for Ca cervix

A

47-62%
Incidence has reduced by 75 to 80%
Death reduced by 70%

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8
Q

Most common type of HPV responsible for Ca cervix and Also most malignant HPV

A

M/C - HPV 16
Most malignant - HPV 18

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9
Q

Transformation zone means

A

Area between columnar epithelium and Squamous epithelium where columnar cells are converting constantly into Squamous cells

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10
Q

Transformation is how much cm away from external os

A

1.7 to 2.3cm

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11
Q

When to do Pap smear

A

For >21 years all women
In India, usually 3 years after begining of sexual activity
21-29 yrs : once in 3 years if Pap smear is negative

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12
Q

Risk factors of Ca Cervix

A

HIV 1 and 2
HSV 1 and 2
Commercial sexual workers
Partners with STDs
Multiparous women
Immunocompromised
Low socioeconomic status
Smokers
Early Intercourse (<16 yrs) - more exposure

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13
Q

Pap smear frequency after 30 yrs of age and other tests done

A

Once in 3 years if Pap smear is negative
Co Test - Pap + HPV DNA - once in 5 yrs

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14
Q

Pap smear after 65 yrs of age

A

Stop doing pap smear, specially if Last 3 pap smears are negative or 2 Co tests went negative

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15
Q

Stain used to see pap smear on microscope

A

Papanicolaou stain

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16
Q

Abnormal finding in Pap smear

A

Big nucleus
Reversal of nucleus cytoplasmic ratio

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17
Q

Dysplasia classification

A

If <1/3 Abnormal cells - Cervical inter epithelial Neoplasia 1 (CIN 1)
If >1/3 and <2/3 Abnormal cells - CIN 2
If >2/3 cells are Abnormal - CIN 3
If all cells are Abnormal - Carcinoma insitu

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18
Q

Bethesda classification

A

Low grade Squamous interepithelial lesion (LGSIL) - CIN 1
High grade Squamous interepithelial lesion (HGSIL) - CIN 2,3, Carcinoma insitu

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19
Q

CIN 1 can change into CIN 3 and CIN 3 to Ca cervix in how many years

A

CIN 1 to 3 - 5 years
CIN 3 to Ca cervix - 10 years

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20
Q

What to do if CIN 1 is +ve on Pap smear

A

CIN is not a precursor
Frequent pap smear once in 6 months
Antiviral or antibiotics
HPV DNA Assessment

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21
Q

Precursors of Ca Cervix

A

CIN 2 and 3

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22
Q

What to do if CIN 1 +ve for > 2 years

A

Continue surveillance or
Ablation/treatment

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23
Q

Which test need to do confirm CIN 3

A

Colposcopic Biopsy or
Can do visual inspection under Acetic acid or Lugol’s iodine

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24
Q

Colposcopic Biopsy procedure

A

Vaginal Examination under illumination and magnification
Can see if there is any abnormal area

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25
Highlighters used in case of Colposcopic Biopsy to see abnormal areas and Findings
1) Acetic acid - Rapidly dividing areas will become white ij color (Acetowhite areas) - take sample 2) Schillers or Lugol iodine - Stains glycogen rich areas - become Mahogany's brown color - sample is taken from unstained areas
26
CIN 3 management if Biopsy finding shows some cells already invading into stroma of cervix
Invasive cancer cervix Treatment - Radical Hysterectomy
27
CIN 3 Management if Biopsy finding shows abnormal cells only in surface, no invasion
Biopsy Proven CIN 3 Management -1) Excision of transformation using a large loop AKA Loop electrosurgical excision procedure (LEEP) 2) Laser ablation - requires too much training, expensive 3) Cryocautery
28
Management of CIN 3 for >35 yrs and >40 yrs patient
>35 yrs - Conization >40 yrs - Hysterectomy
29
Clinical features seen in Ca Cervix
Abnormal vaginal bleeding (M/C postcoital) Dirty foul smelling discharge Uremia Pain Pyometra (Pus in uterus) - M/C bcz of Ca Cervix Post Menopausal bleeding Cancer cachexia
30
Diagnosis method used in case of GSIL/CIN 3, Post coital Bleeding or Carcinoma in situ
Colposcopic cervical Biopsy
31
Management in case of Adenocarcinoma in situ of cervix
Hysterectomy
32
Management in case of Vulval interepithelial neoplasia 3 (VIN 3)
Superficial excision or laser ablation
33
Staging of Ca Cervix is done
Done clinically Per speculum exam Per vaginal exam Per rectal exam Cystoscopy Proctoscopy Imaging - USG, CT, MRI, PET CT
34
Staging Of Ca Cervix
Stage 1 - Stage 1A (1A1 And 1A2) , Stage 1B (1B1, 1B2 And 1B3) Stage 2 - Stage 2A (2A1, 2A2), Stage 2B Stage 3 - Stage 3A, Stage 3B, Stage 3C (C1 and C2) Stage 4 - Stage 4A, Stage 4B
35
Stage 1 of Ca Cervix
Limited to Cervix Stage 1A - Microscopic cancer, A1 - Depth <3mm, A2 - 3-5mm Stage 1B - Macroscopic/Clinically obvious, B1 - <2cm, B2 - 2 to 4cm, B3 - >4cm
36
Stage 2 of Ca cervix
Vaginal involvement Stage 2A - Upper vagina, 2A1 - <4cm, 2A2 - >4cm Stage 2B - Parametrial Involvement
37
Stage 3 of Ca cervix
Stage 3 A - lower 1/3rd vagina Stage 3B - Parametrial involved till pelvic sidewall - ureter might get compressed (Hydronephrosis) Stage 3C - C1 - Pelvic LN involvement C2 - Paraaortic LN involvement
38
Stage 4 of Ca cervix
4A - Bowel and bladder involvement 4B - Distant metastasis
39
Most common stage of presentation of Ca cervix in India
Stage 3B
40
Which area of cervix is M/C involved in Ca cervix
Anterior lip of Cervix
41
Radiotherapy can be done for which stages in case of Ca Cervix
Good for all stages
42
Chemo radiation is provided in which stages of Ca Cervix
Stages >2B Or >2A2
43
Treatment of Stage 1A1 without lymphovascular space invasion
Conization or Extrafascial Hysterectomy
44
Treatment of Stage 1A1 With Lymphovascular space invasion
Radical Trachelectomy or Radical hysterectomy + Pelvic Lymphadenectomy or sentinel LN biopsy (Ext. Iliac LN > Obturator LN)
45
Treatment of Stage 1A2 and 1B1
Stage 1A2 - >3mm <5mm Stage 1B1 - >5mm <2cm Radical Trachelectomy or Radical hysterectomy + Pelvic Lymphadenectomy or sentinel LN biopsy
46
Treatment of Stage 1B2
>2cm <4cm Radical hysterectomy + Pelvic Lymphadenectomy
47
Treatment of Stage 1B3
>4cm Chemo radiation
48
Treatment of Stage 2A1
<4cm + upper vagina Radical hysterectomy + Pelvic Lymphadenectomy or chemoradiation
49
Treatment of Stage 2A2
>4cm + upper vagina Chemoradiation
50
Most common histopathology form of Ca Cervix
Squamous cell carcinoma
51
Histopathological variants of Ca cervix
Squamous cell carcinoma Large cell keratising Large cell non keratising Small cell variant Adenocarcinoma cervix
52
M/C cause of death in Ca cervix
Uremia
53
2nd and 3rd M/C cause of death in case of Ca Cervix
2nd M/C - Hemorrhage 3rd M/C - Infection
54
Vaccine for prevention of Ca Cervix and Variants protected by them
Cervarix - 16,18 Gardasil - 6,11,16,18 Gardasil 9 - 9 valent (6,11,16,18 + 31,33,35,45,52,58) - Given to 9-45 years all women
55
Gardasil 9 effectiveness before and after exposure
Before exposure - 90% effective After exposure - 40% effective
56
Gardasil 9 schedule
0 day - 2 months - 6 months
57
Treatment if pregnant women shows Malignant cell +v3 on pap smear
Conization for confirmation (done >12 wks) - abortion chances decreases
58
Treatment of Stage 1A in Pregnant women
Go till term - C section - Radical hysterectomy + Lymphadenectomy
59
Treatment in case of Stage 1B in Pregnant women
Fetal lung maturity >28 wks - C section - Radical Hysterectomy + Lymphadenectomy 4 week wait maximum
60
Treatment of Stage 2 to 4 in Pregnant women
Radiotherapy Beyond 28 wks - C section - Radiotherapy 1st trimester - Radiotherapy (Baby will abort himself) 2nd trimester - Try and see if gets viability

Obstetrics And Gynecology (2 decks)

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