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Flashcards in Female Genital 1 Deck (38):
1

What is necessary for the development of most cervical cancer?

HPV- high risk HPVs are the single most important factor in cervical oncogenesis

2

What are the two most high risk HPV types?

16 and 18

(31,33,45,51)

3

Viral proteins E6 and E7 inactivate what?

p53 and Rb respectively

4

In most cases the viral DNA is maintained separately from the host DNA as an episome, but what happens in cases of malignant transformation?

viral DNA is integrated into the host genome

5

What percent of HPV infections are transient?

90%
-not detectable within a few years
-women whose infections persist are at greatest risk of developing cervical lesions

6

What percentage of men and women will be infected with HPV at some time?

80%

7

Is HPV 16 or 18 more common in cervical cancer cases?

16

8

Besides HPV, what are 4 other additional risk factors to cervical carcinoma?

smoking
diet
combined oral contraceptives
immunosuppression

9

T-F cervical cancer is the #1 cause of cancer death in women in the US?

False- 14th it was number 1 in 1950

10

What 2 ways does screening reduce deaths?

1. increasing the detection of invasive cancer at early stages
2. increasing the detection of pre invasive lesions

11

age 21-29 women need what PAP protocol? 30-65? >65?

1. pap every 3 yrs
2. pap and HPV co test every 5 years or pap every 3 years
3. no testing if adequate prior negative testing

12

Where do most cervical carcinomas arise?

at or near the squamocolumnar junction

13

What is a key benefit of the liquid-based pap test? do they have a lower or higher false negative/positive rate?

can also perform HPV testing on the residual sample

(can make multiple slides too)
LOWER FALSE NEGATIVE RATE BUT A HIGHER FALSE POSITIVE RATE

14

Why is regular screeing crucial for paps? what type of cancer is it best at preventing? can they detect pre cancer lesions? what are they not great at preventing?

1. increases sensitivity
2. cervical squamous carcinoma
3. yes
4. adenocarcinomas or any other types of cancers in that area

15

What type of cell does HPV infect? where are they most accessible?

1. basal cells
2. ssquamocolumnar junction

16

How do we obtain a histological biopsy of cervix?

colposcopy

17

What are we looking for in a pap test?

nuclear changes that are surrogate marker for the presence of HPV

18

CINI represents how thick the basal layer ascends? CINII? CINIII?

1. lower third
2. middle third
3. upper third/full thickness (severe dysplasia vs. CIS)

19

What are the 4 key diagnosis made from pap tests?

1. NILM (negative for intraepithelial lesion or malignancy)
2. ASCUS- (atypical squamous cells of undetermined significance)
3.LSIL
4.HSIL

20

Where do ASCUS cells fall into the diagram of histological classifications?

can fall into any of the diagnoses
(therefore, if there is a ASCUS finding then HPV test will be done to look for HPV high risk types)

21

What are the hallmark of low-grade SIL? describe them?

Koilocytes- which are squamous cells with enlarged nuclei, low N:C ratio, crisp perinuclear clearing (indicative of presence of HPV)

22

What do we see in colposcopy of high grade SIL (HSIL)/CINII

More dense acetowhite areas and punctations due to abnormal blood vessels. GETS WORSE AND MORE EXTENSIVE FOR WORSE LESIONS

23

Do we still see koliocytes in CIN3?

No

24

In pap of HSIL, are single cells often present?

Yes…unlike LSIL and lesser grade lesions

25

What is the management of women with HSIL?

immediate loop electrosurgical excision or colposcopy with assessment

26

What is the goal of excisional procedures like the LEEP or cold knife?

remove all HPV related lesions with clear margins

27

What is the most common type of cervical carcinoma?

squamous cell 75%
adenocarcinoma 15%

28

What are the strict requirements for micro invasive carcinoma?

less than 3mm depth and 7mm horizontal extent

29

Most patients with carcinoma of cervix have what symptom? what other symptoms are common?

1. NONE!
2. post-coital bleeding, vaginal bleeding, vaginal discharge

30

What is a strong sign of invasive squamous cell carcinoma?

desmoplasia

31

What is difficult about cervical adenocarcinoma?

more difficult to sample on pap and also more difficult to interpret for pathologist

32

What do we see histologically in cervical adenocarcinoma in situ?

glands with pseudo stratified hyper chromatic nuclei with apoptoses and mitoses

33

What do we see histologically in invasive cervical adenocarcinoma

malignant haphazard glands with irregular branching, infiltrating deep into stroma

34

Does invasion occur first in the pelvic soft tissues or the muscle of the bladder or rectum?

pelvic soft tissues

35

What stage is confined to the cervix? 5 year survival?

I 80-93%
surgery or radiation

36

What stage extends beyond the cervix but not to the pelvic sidewall or lower third of vagina? 5 year survival?

II 60%
radiation

37

What stage extends to pelvic sidewall and/or lower third of the vagina? 5 year survival?

III 34%
radiation

38

What stage involves extension beyond the true pelvis and may involve bladder or the rectum? 5 year survival?

IV 15%
radiation