Cervical Cancer

Question 1

cancer of female reproductive system that is staged clinically

Answer 1

cervical cancer (C linically = C ervical); allows staging to occur in low resource setting

Question 2

primarily spreads locally and via lymphatics

Answer 2

squamous cell carcinoma of the cervix

Question 3

may spread hematogenously (3)

Answer 3

• adenocarcinoma cervix
• neuroendocrine tumors
• small cell tumors cervix

Question 4

treatment for cervical cancer is determined by:

Answer 4

clinical stage

Question 5

cervical cancer incidence can be substantially decreased by:

Answer 5

improving adolescent HPV vaccination rates

Question 6

Type of screening used for cervical cancer

Answer 6

cervical cytology screening

Question 7

T or F:

High-risk HPV infection is necessary and sufficient for cervical cancer development

Answer 7

False:

High-risk HPV infection is necessary but INSUFFICIENT for cervical cancer

Question 8

___ % HPV + women will resolve HPV on own within 24 months (if intact immune system)

Answer 8

90%

Question 9

HPV __ & __ account for 90% genital warts

Answer 9

HPV 6 & HPV 11

Question 10

most carcinogenic HPV

Answer 10

HPV 16; (55-60% all cervical cancers)

Question 11

2nd most carcinogenic HPV

Answer 11

HPV 18 (10-15 % all cervical cancers)

Question 12

HPV is a __ (shape), ___ (strands), ___ (nucleic acid) virus

Answer 12

circular, ds, DNA virus

Question 13

RFs for oncogenic HPV:

Answer 13

• immunocompromised (transplant, HIV)
• smoking
• early age at first intercourse
• multiple partners
• other STIs
• low SES (poor nutrition)

Question 14

Cervical cancer is a fast or slow process?

Answer 14

very SLOW process; may take 30 years to become invasive cancer

Question 15

accounts for 80% of cervical cancers

Answer 15

squamous cell carcinoma

Question 16

second most common type of cervical cancer

Answer 16

adenocarcinoma: HPV 16 and 18 are present in 90% of cervical adenocarcinomas

Question 17

HPV 18 has highest association with what type of cervical cancer?

Answer 17

cervical adenocarcinoma

Question 18

ages of males and females for HPV vaccination (as recommended by CDC and ACIP)

Answer 18

female: 11-26 y.o.
male: 11-12 with “catch-up” to 26 y.o.
(nonavalent = all 11 and 12 year olds)

Question 19

types of HPV vaccines (3) and what they cover

Answer 19

quadrivalent: 6, 11, 16, 18
bivalent: 16, 18
nonavalent: 6, 11, 16, 18, 31, 33, 45, 51, 58

Question 20

efficacy of HPV vaccines (if naive to HPV genotype when vaccinated)

Answer 20

nearly 100%

Question 21

primary prevention for cervical cancer

Answer 21

HPV vaccine

Question 22

secondary prevention for cervical cancer

Answer 22

cervical cytologic screening

Question 23

initial screening for cervical cancer begins at age:

Answer 23

21

Question 24

cervical cytology screening recommendations:

Answer 24

initial at age 21; every 3 years ages 21-65

Question 25

reason for not screening for cervical cancer prior to age 21

Answer 25

- 90% HPV infections are naturally resolved within 24 mos in healthy adolescents - adolescent cervix is immature and has higher incidence of HPV-related dysplasia - unnecessary treatment has economic, emotional and future childbearing implications (sig. increase in premie births)

Question 26

Exceptions for cervical cytology screening recommendations:

Answer 26

- immunosuppressed - HIV - DES exposure in utero - prior cervical cancer or HG dysplasia treatment

Question 27

symptoms of cervical cancer include:

Answer 27

- abnormal bleeding (b/w periods, w/ intercourse, after menopause - unusual vaginal discharge - leg pain, pelvic pain - anuria - NONE

Question 28

diagnosis of cervical cancer is made by:

Answer 28

- screening test: cervical cytology - confirmed by biopsy - (biopsy is sufficient if visible tumor is present)

Question 29

20-30% risk of CIN 3+ over 5 years is predicted by:

Answer 29

HPV 16 persistence of 1-2 years

Question 30

30% probability of invasive cervical cancer over 30 years is predicted by:

Answer 30

untreated CIN 3 (VERY SLOW) (treated has 1% probability)

Question 31

T or F: Debulking is used for treating cervical cancers

Answer 31

False: spread is wide and is difficult to get negative margins with debulking

Question 32

Pattern of spread for cervical cancers: - local invasion or distant mets? - lymphatic or hematogenous? - retro or intraperitoneal?

Answer 32

- local invasion - lymphatic spread (SCC) AND hematogenous spread (adenocarcinoma, NE tumor, small cell tumor) - intraperitoneal invasion (spread wide to pelvic wall) = poor prognosis

Question 33

cervical cancer limited to cervix is stage:

Answer 33

I

Question 34

cervical cancer in pelvic side wall and/or lower third of vagina is stage:

Answer 34

III (5 yr survival = 47-50%)

Question 35

cervical cancer in adjacent organs and beyond true pelvis is stage

Answer 35

IV(20-30% 5 yr)

Question 36

cervical cancer in uterus/parametria/vagina

Answer 36

stage II

Question 37

treatment of cervical cancer with distant mets (IV):

Answer 37

systemic chemotherapy

Question 38

radical hysterectomy with pelvic LN dissection is performed in stage ___ cervical cancer

Answer 38

early stage (1-1B)

Question 39

chemoradiation as main therapy is indicated in ___ stage cervical cancer

Answer 39

locally advanced (1B2-4A)

Question 40

Recurrence rate is ___ within 2 years

Answer 40

80% (really only get 1 shot at treating)

Question 41

Favorable prognostic factors for recurrence

Answer 41

- localized, ventral pelvis - disease free interval > 6 mo - size

Question 42

-pelvic exenteration is indicated if: | and involves:

Answer 42

- isolated central recurrence - removal of all pelvic reproductive organs, bladder, distal ureters, pelvic floor, rectum, anus - reconstruct via urostomy, colostomy and possibly vagina