Exam 2 Cervical Dz Flashcards Preview

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Flashcards in Exam 2 Cervical Dz Deck (33):
1

Cervical cells: Inside cervix?

Outside cervix?

Inside = columnar epith

Outside = squamous epith

2

Cervical Intraepithelial Neoplasia (CIN):

High-grade lesions U seen in what age group?

Invasive CA U seen in what age group?

25-35yo

>40yo

3

CIN caused by?

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

4

CIN risk factors? (6)

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

5

CIN screening initiated?

21 regardless of sex activity

EXCEPT <21 HIV+ or chronic suppressive therapy

6

CIN screening F/U? (4)

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

7

Diethylstilbestrol is?

Why do we care?

Med given to preggos in 70s

Causes vag/cerv CA, BCA, infert

8

Cervical CA screening stopped when?

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

9

Cervical CA screening for hysterectomy?

Stop at removal u/l _hx of CIN2/3,
then annual x 20 yrs regardless of age

10

Specimen for cervical cytology must include?

endocervical/transformation zone

11

Cervical Cytology: ASC-US is?

Next step in testing?

Atypical cells of u/k significance

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

12

ASC-US w/o HPV caused by?

Inflamm
Vulvovaginal atrophy

13

ASC-US in 21-24yo?

repeat cytology at 12 mo

14

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

> 24yo?

21-24yo?

Assume HPV DNA ∴ no HVP test until post-meno

Colposcopy

Repeat cytology 12 mo

15

LSIL presentation?

U similar to CIN I
Enlarged, hyperchromatic nuclei w/ abundant cytoplasm

16

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

Assume HPV
REFER all ages for colposcopy

17

HSIL presentation?

U similar to CIN2/3, AIS
Enlarged, hyperchromatic nuclei w/ little or no cytoplasm

18

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

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

19

Endocervical cells on pap indicate?

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

20

CIN Type 1?

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

21

CIN Type 2?

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

22

CIN Type 3?

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

23

Colposcopy: Satisfactory when?

Unsatisfactory when?
Next step?

Complete visualization of transf zone

Incomp vis of tranf zone ->
Must endocervical curettage

24

CIN tx: Ablation?

F/U? (2)

S/E? (4)

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

25

CIN tx: Excision?

F/U?

S/E?

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

26

AdenoCA in situ (AIS) is? (5)

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

27

AIS diagnostics?

Colpo w/ endocervical curettage and bx

28

AIS tx?

Cold knife conization
Hysterectomy

29

Cervical CA?

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

30

Cervical CA presentation? (5)

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

31

Cervical CA tx?

From cold knife to hyst w/ chemo/radio

32

Cervical CA f/u? (3)

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

33

Cervical CA prevention? (5)

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