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Foundations 3 > Disorders of the Cervix > Flashcards

Disorders of the Cervix Flashcards

1
Q

What are Nabathian Cysts

A

Cystic structure that forms when columnar epithelium is covered by squamous epithelium

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2
Q

How do Nabothian Cysts appear?

A

Appear as translucent or yellow

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3
Q

How do Nabothian Cysts present?

A

Asymptomatic and benign. Only seen during speculum exam

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4
Q

Do Nabothian Cysts require excision?

A

No

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5
Q

What is the etiology behind developing Cervical polyps?

A

Etiology is unknown but may be due to chronic inflammation of cervical canal

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6
Q

What is the size for Cervical polyps?

A

Usually <3cm

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7
Q

What is a complication of cervical polyps?

A

May cause post-coital bleeding or abnormal uterine bleeding

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8
Q

Treatment for Cervical polyps?

A

Polypectomy

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9
Q

What are the Histologic layers Cervical Intraepithelial Neoplasia?

A

Ectocervix
Tranformation zone
Endocervical canal

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10
Q

What is the in the Ectocervix

A

slide 8

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11
Q

Transformation zone?

A

slide 8

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12
Q

Endocervical canal

A

slide 8

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13
Q

Which viruse is responsibile for Cervical Intraepithelial Neoplasia?

A

HPV 16

HPV18

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14
Q

Which type of cervical cancer is HPV 16 responsible for?

A

Squamous Cell Carcinomas 50-60%

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15
Q

Which type of cervical cancer is HPV 18 responsible for?

A

Adenocarcinomas 40-60%

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16
Q

Risk factors for HPV Infection?

A 
Multiple sexual partners***
Smoking
Carcinogens found in cervical mucus
Immunosuppression
Early onset of sexual activity
Hx of VIN and Vain
History of STD’s
Long-term oral contraceptive use
      \+/- Estrogen receptors in HPV gene
Multiparity
     Maintenance of transformation zone
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17
Q

Which HPV types can block the protective apoptotic process?

A

HPV E6 and E7

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18
Q

What vaccine used for HPV?

What must be done after receiving the vaccine?

A

Gardasil 9

Require ongoing Pap smears based on age appropriate guidelines

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19
Q

What is another screening tool used besides a PAP smear for HPV

A

HPV DNA testing

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20
Q

What age is recommended to start PAP smears?

A

Start 21 despite the age of sexual debut

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21
Q

What age can you start to consider HPV/Cervical Cancer screenings?

A

No later than 25

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22
Q

Do screenings prior to age 21 reduce rate of cervical cancer?

A

NO

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23
Q

What population do these recommendations for Cervical Cancer not apply to?

A

High risk populations (immunocompromised)

Should be screened earlier

24
Q

When screening adolescents for HPV what kind of precautions or educations should be done?

A

Contraceptive Counseling
STI screening
Urine sample
Speculum exam not required in asymptomatic women
HPV vaccination education/administration
Safe sex practices
No Pap smear unless in high-risk population

25
What are screening guidelines are recommended for 21-29?
Cytology performance alone q 3 years Do not perform HPV DNA testing
26
What are screening guidelines recommended for 30-64 yr women?
Cytology (+) HPV DNA testing q 5 years or Cytology alone q 3 years
27
Which type of patients would need yearly cervical cancer screenings?
High risk patients 1. HIV positive women - Screened q 6 mos the year of diagnosis then q year - Begin screening at the age of diagnosis 2. Immunocompromised 3. Personal history of cervical cancer 4. History of CIN II/III 5. Exposure to Deithystilbestrol in utero (given to women to suppress preg. complications)
28
When do you stop screening for Cervical cancers?
Stop at the age of 65 if in the past 10 years…. 1. Patient has evidence of 3 prior consecutive negative results with cytology alone OR 2. Two consecutive negative Co-testing results 3. The most recent test has to have occurred within 5 years 4. Can not have a history of CIN 2+ within last 20 years
29
When does cervical screening stop in women after hysterectomy (cervix is removed)?
- Stops at the time of surgery - Hysterectomy performed for benign disease - No history of CIN 2 + within 20 years
30
What must you do while performing speculum examination and an abnormal cervical lesion?
Perform BIOPSY NOT Pap Smears * A Pap smear is a screening tool whereas biopsy is diagnostic
31
While performing cytology tests, what is recommended to do if we find ASC-US in 21-24 year olds?
Preferred to repeat cytology in 1 year
32
Recommendations for ASC-US in Age 25 and up
Must reflex to HPV DNA Negative HPV DNA = NORMAL cytology So repeat co-testing in 3 years Postive HPV DNA = colopscopy
33
What is the cause of ASCUS cytology in the absence of HPV?
Chlamydia trachomatis, Herpes simplex Vulvovaginal atrophy
34
Recommendations for LSIL types found in 21-24 y/o?
Same as ASCUS
35
Recommendations for LSIL in 25+
Refer for colposcopy despite HPV result OR Repeat co-testing in 1 year if HPV DNA testing is negative Lesions usually consistent with CIN I
36
If you find HSIL/ASC-H (High grade) types what can we safely assume is present?
HPV DNA
37
Recommendations for HSIL/ASC-H (High grade) cells?
Refer for colposcopy despite HPV result (all ages) Negative HPV HSIL carries a 5 year risk for CIN 3+ of 29% Lesions usually consistent with CIN II-III, AIS
38
What are recommendations for Negative cytology samples with no endocervical cells: 21-29?
Routine screening – repeat Pap in 3 years | DO NOT perform HPV DNA testing
39
What are recommendations for Negative cytology samples with no endocervical cells: 30 and above
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
40
What causes an Unsatisfactory cytology test?
Insufficient sampling, so HPV test can be FALSELY neg.
41
Recommendations for Unsatisfactory cytology?
No HPV testing - Repeat Pap in 2 – 4 months (any age) - Do NOT add on HPV test if not initially ordered HPV testing performed at age 30 and up - Negative: Repeat Pap in 2 – 4 months - Positive: Refer for colposcopy
42
Women 30+ years with negative cytology but positive high risk HPV DNA should get what screenings?
Colposcopy if genotype is (+) for HPV 16/18 Repeat co-testing in 12 months for non-HPV 16/18 If negative in 12 months repeat co-testing in 3 years If positive in 12 months refer for colposcopy
43
What do the grades od Cervical Intrepithelial Neoplasia indicate?
Grades I,II,III get worse as you go down
44
Screenings for ASCUS or LSIL ages 21-24?
Cytology ALONE in 12 months
45
Management of Persistent ASCUS/LSIL at 24 months for Ages 21-24
Colposcopy
46
Management for ASC-H/HSIL (high grade) at ages 21-24 years
Colposcopy
47
Management of ASCUS/LSIL in Ages 24 or older? What if is a Persistent CIN 1 for 24 months?
ASCUS or LSIL/CIN 1, negative HPV: Co-testing at 12 months -Negative: Co-test in 3 years -Abnormal: Colposcopy LEEP Vs Continued follow-up
48
Managment for HSIL/ASC-H (high grade) in ages 21-24?
Immediate triage to LEEP is unacceptable Colposcopy ``` HSIL/CIN I or less -Cytology and colposcopy q 6 months up to 24 months LEEP is indicated for the following: -Persistent HSIL (24 mos) -CIN 2+ -Unsatisfactory colposcopy ```
49
Management of HSIL/ASC-H in Ages 25 and up?
Colposcopy or LEEP
50
What is LEEP?
Loop Electrosurgical Excision Procedure High electrical current density results in rapid heating of the nearby tissue. A steam envelope surrounding the wire is created which vaporizes adjacent tissue. Tissue sent for pathology 90-95% cure rate that has replaced laser surgery for treatment of CIN
51
LEEP Follow Up recomendations
- Avoid heavy lifting for 4 weeks to avoid bleeding - Malodorous vaginal discharge for 2-3 weeks - Avoid intercourse for 4 weeks - Avoid douches, creams and tampons within the vagina for 4 weeks - First menses after LEEP is heavier due to partial removal of endocervical canal
52
What are complications after performing a LEEP?
``` Bleeding Infection Cervical oblieration/incompetence Associated with pre-term delivery*** Asociated with pre-term delivery after PPROM ```
53
What are LEEP followup screenings recommendations?
Repeat co- testing at 12 and 24 months - Both negative: re-test in 3 years - Abnormal: repeat colposcopy with ECC - Continue age appropriate screening for at least 20 years even if > 65 ``` (+) margins after LEEP -Repeat cytology and ECC at 4 – 6 months Persistent CIN 2+ following LEEP -Repeat LEEP -Hysterectomy ```
54
What is the 2nd most coomon cancer in women worldwide?
Cervical Cancer
55
What is the clinical presentation for cervical Cancer?
- Frequently ASYMPTOMATIC - Abnormal vaginal bleeding - Postcoital bleeding - Unilateral pelvic pain with radiation into the hip or thigh - Sign of advanced disease - Vaginal discharge - Watery, mucoid, purulent, malodorous
56
What is most common clinical symptom for Cervical Cancer?
Abnormal vaginal bleeding

Foundations 3 (25 decks)

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