Exam 2 Cervical Dz

Question 1

Cervical cells: Inside cervix?

Outside cervix?

Answer 1

Inside = columnar epith

Outside = squamous epith

Question 2

Cervical Intraepithelial Neoplasia (CIN):

High-grade lesions U seen in what age group?

Invasive CA U seen in what age group?

Answer 2

25-35yo

> 40yo

Question 3

CIN caused by?

Answer 3

HVP:
16/18 = high risk
6/11 = low risk

Question 4

CIN risk factors? (6)

Answer 4

HIV/Immunosupp
Smoking
Sluts
Early sex
Long-term oral contr
STds

Question 5

CIN screening initiated?

Answer 5

21 regardless of sex activity

EXCEPT <21 HIV+ or chronic suppressive therapy

Question 6

CIN screening F/U? (4)

Answer 6

21-29 yo: cytology only Q 3yrs, NO HPV testing

30-65 yo: Cytology + HPV Q 5 yrs

High risk: yearly

HIV: 1st at time of dx, then Q 6 mo x 2, then annually

Question 7

Diethylstilbestrol is?

Why do we care?

Answer 7

Med given to preggos in 70s

Causes vag/cerv CA, BCA, infert

Question 8

Cervical CA screening stopped when?

Answer 8

65yo IF in past 10 yrs:
3 consecutive neg cytology results
OR
2 consec neg co-testing WITH most recent w/i 5 yrs
AND not high risk

Question 9

Cervical CA screening for hysterectomy?

Answer 9

Stop at removal u/l _hx of CIN2/3,

then annual x 20 yrs regardless of age

Question 10

Specimen for cervical cytology must include?

Answer 10

endocervical/transformation zone

Question 11

Cervical Cytology: ASC-US is?

Next step in testing?

Answer 11

Atypical cells of u/k significance

Must reflex to HPV DNA:
Neg = N
+ = colposcopy if > 24yo

Question 12

ASC-US w/o HPV caused by?

Answer 12

Inflamm

Vulvovaginal atrophy

Question 13

ASC-US in 21-24yo?

Answer 13

repeat cytology at 12 mo

Question 14

Cervical Cytology: Low-Grade Squamous Intraep Lesion (LSIL) next step in testing?

> 24yo?

21-24yo?

Answer 14

Assume HPV DNA ∴ no HVP test until post-meno

Colposcopy

Repeat cytology 12 mo

Question 15

LSIL presentation?

Answer 15

U similar to CIN I

Enlarged, hyperchromatic nuclei w/ abundant cytoplasm

Question 16

Cervical Cytology: High-Grade Squamous Intraep Lesions (HSIL) next step testing?

Answer 16

Assume HPV

REFER all ages for colposcopy

Question 17

HSIL presentation?

Answer 17

U similar to CIN2/3, AIS

Enlarged, hyperchromatic nuclei w/ little or no cytoplasm

Question 18

30-65yo w/ neg Cytology + high risk for HPV, next step testing?

Answer 18

HPV DNA typing for 16/18
OR
Repeat co-test in 12 mo (not 5 yrs)

Question 19

Endocervical cells on pap indicate?

Answer 19

Only reported if 40+yo
P normal or pathological shedding
Relate to menstrual hx

Question 20

CIN Type 1?

Answer 20

Lower 1/3 of epith lining
Seen w/ LSIL
U regress in 12 mo

Question 21

CIN Type 2?

Answer 21

Lower 2/3 of epith lining
Seen w/ HSIL
1/2 regress, 20% to Type 3, 5% to invasive CA

Question 22

CIN Type 3?

Answer 22

More than 2/3 of epith lining
Seen w/ HSIL
1/2 regress, 40% to CA

Question 23

Colposcopy: Satisfactory when?

Unsatisfactory when?
Next step?

Answer 23

Complete visualization of transf zone

Incomp vis of tranf zone ->
Must endocervical curettage

Question 24

CIN tx: Ablation?

F/U? (2)

S/E? (4)

Answer 24

NO2 destruction (CIN 1 only)

No sex 4 wks
Healed by 8 wks

Uterine cramping
Profuse, smelly, watery d/c for 4 wks
Cervical stenosis
Less bad preggo outcomes than other tx

Question 25

CIN tx: Excision? F/U? S/E?

Answer 25

Loop Electrosurgical Excision Procedure (LEEP) No heavy lifting No sex 4 wks Stinky d/c 3 wks Ist period post is heavier Obliterated/Incomplete/Stenotic cervix Pre-term delivery

Question 26

AdenoCA in situ (AIS) is? (5)

Answer 26

``` Aggressive precursor to cervical adenoCA U by 37yo U AGS/HSIL Endocervical gland involvement w/ atypical columnar epith U high in canal w/ skip lesions ```

Question 27

AIS diagnostics?

Answer 27

Colpo w/ endocervical curettage and bx

Question 28

AIS tx?

Answer 28

Cold knife conization | Hysterectomy

Question 29

Cervical CA?

Answer 29

U by 50yo U HPV 16 SCC (worst) P HPV 18 AdenoCA

Question 30

Cervical CA presentation? (5)

Answer 30

``` Asympt U Abn vag bleeding Post sex bleeding Unilat pelvic pain, rad to hip/thigh Vag d/c ```

Question 31

Cervical CA tx?

Answer 31

From cold knife to hyst w/ chemo/radio

Question 32

Cervical CA f/u? (3)

Answer 32

Q 4mo x 2 yrs, then Q 6mo x 3 yrs Annual pap Annual CXR x 5 yrs

Question 33

Cervical CA prevention? (5)

Answer 33

``` HPV vaccine No sex Barrier protection Reg paps Tx pre-cancers ```