Cervical Dysplasia & Cancer

Question 1

This area of the cervix has glandular columnar cells

Answer 1

Endocervix

Question 2

This area of the cervix has squamous cells

Answer 2

Ectocervix

Question 3

where the glandular columnar cells meet the squamous cells on cervix is known as

Answer 3

Squamocolumnar Junction (SCJ)

Question 4

when is squamous metaplasia most active

Answer 4

during adolescence / pregnancy

Question 5

where do nearly all cervical neoplasia develop?

Answer 5

w/in transition zone of SCJ

Question 6

what is a increased risk for cervical CA?

Answer 6

early age of 1st sexual intercourse / 1st pregnancy

Question 7

Dietary deficiencies of what may alter immunity and promote viral persistence leading to cervical dysplasia

Answer 7

Vit A, C, E, beta carotene, folic acid

Question 8

_____ –> decreased ______ –> allows genetic mutations over time –> _____

Answer 8

Old Age
Immunocompetence
Cancer

Question 9

68y/o woman has a Hx of taking DES (Diethylstilbestrol) to prevent miscarriage in 1971 what does this put her at risk of

Answer 9

clear cell adenocarcinoma of vagina and cervix

Question 10

Demographic risk factors for cervical neoplasia

Answer 10

Ethnicity (latin American, U.S. minorities)
Low socioeconomic status
increased age

Question 11

Behavioral risk factors for cervical neoplasia

Answer 11

Early coitarche
multiple sexual partners
male partner w/multiple prior sexual partners
tobacco smoking
dietary deficiencies

Question 12

Medical risk factors for cervical neoplasia

Answer 12

Cervical high-risk HPV Infx
Exogenous hormones (combine hormonal contraceptive)
parity
immunosuppression
inadequate screening

Question 13

What is considered mild cervical dysplasia

Answer 13

Cervical Intrepithelial Neoplasia 1 (CIN 1)
abnormal cells confined to lower 1/3 of squamous epithelium
manifestation of HPV
(most regress after few years)

Question 14

What is considered moderate cervical dysplasia

Answer 14

Cervical Intrepithelial Neoplasia 2 (CIN 2)
abnormal cells confined to middle 1/3 of squamous epithelium
mix of low and high grade
(~40% regress spontaneously w/in 2yrs)

Question 15

What is considered Severe cervical dysplasia

Answer 15

Cervical Intrepithelial Neoplasia 3 (CIN 3)
abnormal cells confined to upper 1/3 of squamous epithelium
(risk of invasive cancer ~30% in 30yrs)

Question 16

What is considered cervical carcinoma in situ

Answer 16

Full thickness involvement of cervix

Question 17

What CIN is considered precancerous

Answer 17

moderate-severe (CIN 2 and 3)

Question 18

what are the Low Risk HPV

Answer 18

6 / 11
visible genital warts, laryngeal papillomas, minority of subclinical HPV infx
(rarely oncogenic)

Question 19

what are the High Risk HPV

Answer 19

Types: 16 (MC), 18 (2nd MC), 31, 33, 35, 45(3rd MC)

persistent HPV infx required –> cervical cancer

Question 20

Pt w/ a HPV 16/18 leasion lasting >6months will develop what?

Answer 20

Squamous Intraepithelial Lesion (SIL)

Question 21

When do you screen for HPV?

Answer 21

women >/= 30
triage / surveillance of certain cytology abnormalities
post-Tx surveillance

Question 22

how often to complete pap screening in Pt <21

Answer 22

do not screen will likely clear infx

Question 23

how often to complete pap screening in Pt 21-29

Answer 23

pap q 3 yrs

Question 24

how often to complete pap screening in Pt 30-65

Answer 24

pap w/HPV (co-test) q 5yrs

pap alone q 3yrs

Question 25

how often to complete pap screening in Pt >65

Answer 25

no screening needed if no Hx of cervical changes- 3 neg paps in a row; 2 neg co-test in 10 yrs w/most recent in 5yrs

Question 26

Pap results return as ASC-US w/+HPV

Answer 26

Tx like LGSIL --> colposcopy

Question 27

Pap results return as ASC-US w/-HPV or w/o co-testing

Answer 27

repeat pap in 1 year if still abnormal after 1yr --> colpo

Question 28

How to TX pregnant woman with pap results of ASC-US results

Answer 28

Tx as not pregnant NO endocervical curette use or EMB defer colpo until 6wks postpartum biopsy only If high grade lesion

Question 29

How to TX pregnant woman with pap results of ASC-H results

Answer 29

Do NOT defer colpo until postpartum

Question 30

if you are unable to visualize entire transformation zone cant be seen w/colposcopy what should be done

Answer 30

LEEP (Loop electrosurgical excision procedure) | CKC (Cold Knife Cone)

Question 31

what is considered a poor prognostic indicator of cervical cancer that is not included in clinical staging

Answer 31

Lymphovascular spread

Question 32

Majority (70%) of all cervical cancers are what type and arise from where

Answer 32

Squamous Cell; | from ectocervix

Question 33

Adenocarcinomas of the cervix are usually ______ and have a _______ prognosis compared to Squamous cell

Answer 33

mucinous adenocarcinoma; | worse prognosis

Question 34

how to control abnormal bleeding w/cervical cancer

Answer 34

Monsel paste (ferric subsulfate) & vaginal packing

Question 35

How may those w/cervical cancer present

Answer 35

``` watery/purulent/bloody discharge polypoid mass/papillary tissue/ barrel shaped cervix cervical ulceration/glandular mass necrotic tissue enlarged uterus lymphadenopathy (spread) Hydronephrosis (compressing ureters) Constipation ```

Question 36

Tx of Cervical Cancer in pregnancy

Answer 36

early stages- may postpone TX until delivery Advanced stages- Tx may lead to fetal losses