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Repro. Med 3 > Lower Genital Tract Malignancies > Flashcards

Lower Genital Tract Malignancies Flashcards

1
Q

Lifetime risk for HPV in sexually active men and women is at least ___%.

By 50 years of age, at least __% of women will have acquired genital HPV infection.

A

50%

80%

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2
Q

An estimated 74% of new HPV infections occur in sexually active individuals ____-____ y/o

In studies of women ____ y/o, prevalence rates ranged from 28-46%

A

15–24

<25 y/o

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3
Q

__ is a non-enveloped double-stranded DNA virus

A

HPV

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4
Q

Over __ HPV types have been Identified.

Of these, ___-___ are anogenital types and ____-____ are oncogenic types

A

> 100
30-40
15-20 (16, 18, 31, 33, 35, 39, 45, 51, 52, 58)

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5
Q

HPV __ and __ are most often associated with external genital warts.

A

6
11

these cause 90% of genital warts

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6
Q

At what age are women at highest risk for HPV? Men?

A 
W = 20-24 y/o
M = 25-29 y/o
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7
Q

What are RF for HPV?

A

Early age of first coitus
Numerous sexual partners
Uncircumcised
Smoking

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8
Q

___% of HPV is a transient infection

Median time to clearance = ___ months

A

80%

8 months

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9
Q

What types of CA is most common with HPV?

A

Cervical: >95% (70% caused by 16 and 18)
Cutaneous squamous cell: 90%
Anal: >70%
Vaginal/Vulvar/Penile: >50%

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10
Q

The HPV vaccine is approved for ages __-___ y/o

A

9-26 y/o

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11
Q

Cervarix: effective against __ and __HPV types

Gardasil: effective against HPV types __, __, ___, ___

9-valent vaccine?

A

16 and 18

6, 11, 16, 18

6, 11, 16, 18, 31, 33, 45, 52, 53

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12
Q

What are the 3 precursor HPV lesions?

A

Vulvar intraepithelial Neoplasia (40-50 y/o)
Vaginal intraepithelial Neoplasia
Cervical Intraepithelial Neoplasia (30-40 y/o)

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13
Q

With Vulvar Intraepithelial Neoplasia
__% are asymptomatic

Sx include: ___, ___

What does the lesion look like?

A

50% asymptomatic

Pruritis, chronic irritation

Lesion: whitish, thickened, rough, 10-15%, hyperpigmented (watch for ulceration)

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14
Q

How do you dx Vulvar Intraepithelial Neoplasia?

A

High suspicion in pts with abnormal pap, cervical dysplasia

Acetic acid stain
Colposcopy
Bx

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15
Q

What is the tx for Vulvar Intraepithelial Neoplasia?

A

Laser vaporization
Excision
Imiquimod

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16
Q

What is the recurrence rate for Vulvar Intraepithelial Neoplasia after tx?

What can be used to reduce recurrence rate?

A

25-50%

5-Fluoro-Uracil cream

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17
Q

Vulvar CAs make up __-___% of gyn malignancies

A

4-5%

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18
Q

Median age for vulvar CA is __ y/o

A

68 y/o

56% >65, 10% <45

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19
Q

What puts a pt at higher risk for developing vulvar CA? (x4)

A

Poor SES
HVP infxn in younger pts
Smoking
H/O granulomatous venereal infection

20
Q

What are sx of vulvar CA? (x6)

A 
Pruritus
Mass
Ulceration
Bleeding
Discharge
Pain
21
Q

How do you dx vulvar CA?

A

Bx

22
Q

What are the 4 types of vulvar CA types, which are most common?

A

Squamous cell CA: 86%
Melanoma: 5%
Adenocarcinoma: 1%
Other: 8%

23
Q

How do you tx EARLY vulvar CA?

A

Radical wide local excision w/ 2 cm margin

Inguinal lymphadenectomy or sentinel node bx (unilateral if lesion is lateral)

***Radical complete vulvectomy rarely necessary

24
Q

How do you tx LATE vulvar CA?

A

Radiation therapy
Chemotherapy
Radical excision, possible skin flap
**Exenteration rarely necessary (remove bladder, vagina, rectum)

25
Q

What is the survival rate from squamous vulva carcinoma for the following stages:
Localized ___% _____ 5 yr survival
Regional ____% ____ 5 yr survival
Distant ___% _____ 5 yr survival

A

Localized: 60%, 87%
Regional: 31%, 54%
Distant: 5%; 14%

26
Q

The approach to dx and tx of vaginal CA is similar to the tx of ____ CA

Tx includes?

A

Cervical

Surgery
External and intracavitary radiation

27
Q

What is the sensitivity and specificity for the pap smear screen for cervical CA?

A

Sensitivity: 26-92% (high for CA, low for dysplasia)

Specificity: 90-97%

28
Q

How much does a pap smear usually cost and does it actually reduce mortality?

A

$70

It does reduce mortality

29
Q

20%+ false negative results are due to ____ or ____

A

misinterpretation

inadequate sample

30
Q

The pap smear uses the _____ to evaluate the results

A

Bethesda System

31
Q

T/F: Cervical Intraepithelial Neoplasia are asymptomatic

A

T

32
Q

How do you dx a Cervical Intraepithelial Neoplasia?

A

Abnormal Pap smear

  • Colposcopy
  • Directed bx
  • Endocervical curettage
  • Test for high risk HPV types 16, 18
33
Q

What is the tx for the following?

HPV infxn, CIN I : ______
CIN II in young pts : ______
CIN II, III, CIS : _____

A

HPV infection, CIN I : Observation

CIN II in young pts :

  • Close observation if f/u reliable
  • Tx if poor follow-up or persistence

CIN II, III, CIS : Immediate tx

34
Q

What is the tx for Cervical Intraepithelial Neoplasia?

A

Destructive therapy

  • Cryotherapy
  • Laser vaporization

Excisional therapy

  • Loop Electrical Excision Procedure (LEEP)
  • Cold Knife Conization (CKC)
35
Q

What is the median age for cervical CA?

What % of pts are <45 y/o

A

48 yrs

40%

36
Q

What are the RF for cervical CA?

A 
HPV infxn
Young age at first coitus
Multiple partners
Smoking
Low SES
Metropolitan areas
Underdeveloped countries
37
Q

What are the signs of cervical CA?

A

Postcoital spotting (most common)
Vaginal discharge/bleeding
Pelvic pain radiating to the leg
Dysuria / hematuria / rectal bleeding

38
Q

What are signs of cervical CA on the cervix during PE?

A

Friable, exophytic mass
Necrotic ulceration
Barrel shaped cervix

39
Q

What are signs of cervical CA in the PE is you are looking at the pelvis ?

A

Firm mass in the parametrium

Induration of the upper vagina

40
Q

Where may you find lymphadenopathy if a pt has cervical CA?

A

Inguinal

Supraclavicular

41
Q

What are the indications for bx of the cervix?

A

Abnormal findings on exam
Mass or ulceration seen
Abnormal Pap smear

42
Q

What is the most common cervical CA cell type?

A 
Squamous CA (80-90%) 
Adenocarcinoma (5-15%)
43
Q

What is the tx for EARLY Cervical CA lesions?

A

Conization

Simple hysterectomy

Radical hysterectomy

  • radical trachelectomy (small lesions)
  • pelvic lymphadenectomy

External and intracavitary radiation

44
Q

What is the tx for LATE Cervical CA lesions?

A

External radiation therapy

Intracavitary radiation therapy

Interstitial radiation therapy

Sensitizing chemotherapy (Cisplatin, 5-Fu, gemcitabine)

45
Q

What is the cervical CA survival for the following stages:
Localized ___% _____ 5 yr survival
Regional ____% ____ 5 yr survival
distant ___% _____ 5 yr survival

A

Localized: 47%; 91%
Regional: 36%; 57%
Distant: 12%; 16%

46
Q

How can you prevent lower genital tract malignancies?

A 
HPV vaccination
Reduce risk of sexually transmitted infxns
Do not have sex early 
Do not smoke
Get regular screening exams

Repro. Med 3 (14 decks)

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