Neoplastic Disease of the Lower Genital Tract

Question 1

HPV strains that have a low risk

Answer 1

HPV 6, 11, 49, 41, 42

Question 2

HPV strains which are considered “high risk”

Answer 2

HPV 16, 18, 45, 58

Question 3

HPV strains seen in HSIL (CIN II/III)

Answer 3

HPV 31, 33, 35, 51, 52

Question 4

What are the risk factors for increased risk for HPV?

Answer 4

1. Early coitarche
2. Multiple sexual partners (>/6)
3. History of STI
4. OCP use
5. History of vulvovaginal dysplasia

Question 5

Smoking is a risk factor of what CA in the lower genital tract?

Answer 5

Squamous cell CA

NOT adenoCA

Question 6

What are the contents of you bivalent HPV vaccine?

Answer 6

16,18

Question 7

What are the components of your HPV quadrivalent

Answer 7

6,11,16,18

Gardasil 3 doses given at 0,1,6

Question 8

[Secondary screening]

<21 years old, no vaginal intercourse

Answer 8

No screening

Question 9

[Secondary screening]

<21 years old, sexually active at age 18

Answer 9

Screen

Screen 3 years after onset of intercourse but not earlier than 21 years old

Question 10

[Secondary screening]

21-29 years old

Answer 10

Cytology alone

Local setting: annual screening by conventional cytology or biennial screening with liquid based cytology

Question 11

[Secondary screening]

30-65 years old

Answer 11

1. HPV and Cytology Co-testing every 5 years
2. Cytology alone every 3 years

Local setting: annual screening by conventional cytology or biennial screening with liquid based cytology

Question 12

[Secondary screening]

66 years old
3 negative PAP tests

Answer 12

No more screening

Not recommended for >65 years old with 3 consecutive negative Pap test or 2 consecutive negative HPV test

Question 13

[Secondary screening]

66 years old
no history of pap smear

Answer 13

Screen!

Question 14

[Secondary screening: pap smear]

21 years old
Pregnant

Answer 14

Screen!

Question 15

What is the most common squamous abnormality?

Answer 15

ASCUS

Question 16

[Cervical Cytologic Abnormality]

Atypical squamous cells, cannot exclude higher grade lesions

Answer 16

ASC-H

Question 17

[Cervical Cytologic Abnormality]

Consistent with histology reports of low-grade dysplasia or cervical intraepithelial neoplasia (CIN1)

Answer 17

LSIL

May resolve or progress

Question 18

[Cervical Cytologic Abnormality]

more severe dysplasia or CIN 2/3

Answer 18

HSIL

20% will progress to cervical CA

Question 19

[Management of Cytologic Abnormalities]

ASC-US

21-24 years old

Answer 19

Repeat cytology yearly

Question 20

[Management of Cytologic Abnormalities]

LSIL

21-24 years old

Answer 20

Repeat cytology yearly

Question 21

[Management of Cytologic Abnormalities]

ASC-H

21-24 years old

Answer 21

Colposcopy + biopsy and ECC

Question 22

[Management of Cytologic Abnormalities]

HSIL

21-24 years old

Answer 22

Colposcopy + biopsy and ECC

Question 23

[Management of Cytologic Abnormalities]

ASC-US

25 to 65 years old

Answer 23

HPV testing preferred; repeat cytology is acceptable

Question 24

[Management of Cytologic Abnormalities]

LSIL, HPV status unknown

25 to 65 years old

Answer 24

Colposcopy +/- biopsy and ECC

Question 25

[Management of Cytologic Abnormalities] LSIL, HPV negative 25 to 65 years old

Answer 25

Repeat cytology at 1 year; colposcopy acceptable

Question 26

[Management of Cytologic Abnormalities] LSIL, HPV positive 25 to 65 years old

Answer 26

Colposcopy + biopsy and ECC

Question 27

[Management of Cytologic Abnormalities] ASC-H 25 to 65 years old

Answer 27

Colposcopy + biopsy and ECC regardless of HPV status

Question 28

[Management of Cytologic Abnormalities] HSIL 25 to 65 years old

Answer 28

Immediate LEEP or colposcopy + biopsy and ECC

Question 29

[Management of Cytologic Abnormalities] AGC 25 to 65 years old

Answer 29

Colposcopy + biopsy + ECC EM biopsy if >35y/o

Question 30

[Management of biopsy proven lesions] LGSIL (CIN 1) preceded by ASC-US, LSIL, HPV 16+, HPV 18+, persistent HPV

Answer 30

1. Co-testing at 12 months

Question 31

[Management of biopsy proven lesions] LGSIL (CIN 1) Preceded by ASC-H, HSIL

Answer 31

If adequate colposcopy: Ablation or diagnostic excisional procedures If inadequate colposcopy: diagnostic excisional procedures

Question 32

Risk factors for cervical CA

Answer 32

1. HPv 2. Parity >7 3. OCP use >5 years with HPV 4. Current smokers and younger age at smoking 5. Co-infected with chlamydia or HSV 6. HIV 7. Early age at sex <14 y/o 8. Sex partners >6 9. Pregnancy <17 10. No screening 11. Low socio-economic status 12. Poor access to healthcare services,

Question 33

[Cervical CA] arising from ectocervix, most common

Answer 33

squamous cell CA | 85 to 95%

Question 34

[Cervical CA] arising from endocervical columnar epithelium (10-15%)

Answer 34

AdenoCA

Question 35

What is the most common symptom of cervical CA

Answer 35

Vaginal bleeding other ssx: post-coital bleeding, intermenstrual bleeding, brownish, foul-smelling discharge

Question 36

[Cervical CA staging] Stage I

Answer 36

confined to the cervix

Question 37

[Cervical CA staging] Stage II

Answer 37

Cancer extends beyond cervix but not to pelvic wall or lower third of vagina

Question 38

[Cervical CA staging] Stage III

Answer 38

Cervix + pelvic wall + hydronephrosis/non-functioning kidney

Question 39

[Cervical CA staging] Stage IV

Answer 39

Cervix extending to true pelvis or biopsy proven bladder or rectum

Question 40

[Cervical CA treatment] IA1 - Desirous of pregnancy

Answer 40

Negative Margins - BLND Positive margins - repeat cone biopsy/trachelectomy + BLND +/- PALS

Question 41

[Cervical CA treatment] IA1 - Not desirous of pregnancy

Answer 41

EH +/- BSO (+BLND if + LVSI)

Question 42

[Cervical CA treatment] IA2 - if desirous of pregnancy

Answer 42

Radical vaginal or abdominal trachelectomy + pelvic lymphadenectomy

Question 43

[Cervical CA treatment] IA2 - not desirous of pregnancy

Answer 43

RH, BLND, +/- BSO

Question 44

[Cervical CA treatment] IB1, IIA1

Answer 44

1. RH, BLND, +/- PALS +/- BSO | 2. Chemotherapy and pelvic EBRT + brachytherapy

Question 45

[Cervical CA treatment] IVB

Answer 45

Cisplatin based chemotherapy + individualized RT

Question 46

What is the current standard of care and mainstay treatment?

Answer 46

Concurrent chemoradiation Surgery until IIA2

Question 47

[Vulval Intraepithelial Neoplasia] Mild dysplasia

Answer 47

VIN I

Question 48

[Vulval Intraepithelial Neoplasia] moderate dysplasia

Answer 48

VIN II

Question 49

[Vulval Intraepithelial Neoplasia] severe dysplasia - Carcinoma in situ

Answer 49

VIN III

Question 50

[Diagnosis] elongation and widening of rete ridges, white firm cartilaginous lesions with hyperkeratotic changes

Answer 50

squamous cell hyperplasia

Question 51

[Diagnosis] Large pale cells, occurring in nests and infiltrate upward through the epithelium

Answer 51

paget disease

Question 52

Atypia is defined as

Answer 52

1. Loss of polarity 2. Increased N:C ratio 3. Irregular size and shape 4. Prominent nuclei 5. Thick nuclear membrane

Question 53

[Management for premanopausal women: endometrium] hyperplasia without atypia

Answer 53

1. OCP x 6 cycles 2. MPA 10-20mg OD x 14 days Then do UTZ sample endometrium after 3 months. Normal: MPA 5mg x 10days for 12 months Persistent: increase dose 40-100mg daily for 3 months

Question 54

[Management for premanopausal women: endometrium] hyperplasia with atypia, desirous of pregnancy

Answer 54

1. Continuous MPA 10-20mg OD x 3 months 2. Megestrol acetate 40-200mg OD 3. DMPA 150mg q3months 4. LNG-IUS for 1-5 years

Question 55

What factors diminishes the risk of endometrial cancer?

Answer 55

1. Ovulation 2. Progestin therapy 3. Combination oral contraceptives 4. Menopause before 49 years old 5. multiparity

Question 56

[Endometrial CA type] ``` early postmenopause hyperplastic background epithelium Low grade Estrogen dependent ER positive ```

Answer 56

Type 1 Endometrioid CA

Question 57

[Endometrial CA type] ``` Late menopause atrophic high grade non-dependeng ER negative ```

Answer 57

Type 2 Serous papillary

Question 58

[FIGO Grade: Endometrial CA] Stage I

Answer 58

confined to the corpus

Question 59

[FIGO Grade: Endometrial CA] Stage II

Answer 59

invades the cervical stroma but does not extend beyond the uterus

Question 60

[FIGO Grade: Endometrial CA] Stage III

Answer 60

local and/or regional spread of the tumor

Question 61

[FIGO Grade: Endometrial CA] Stage IV

Answer 61

tumor invades the bladder and or bowel mucosa and or distant metastasis

Question 62

What is the mainstay treatment for endometrial CA (if cervix is not involved)

Answer 62

Extrafascial hysterectomy

Question 63

What is the most frequent ovarian epithelial tumor?

Answer 63

Serous Cystadenoma

Question 64

Ovarian tumor that can reach enormous size

Answer 64

Mucinous cystadenoma

Question 65

Ovarian tumor that appears to have "coffee bean" appearing nucleus

Answer 65

Brenner TUmor

Question 66

Most common neoplasm in prepubertal female

Answer 66

Benign cystic teratoma

Question 67

What is the tumor marker of Epithelial tumors

Answer 67

CA-125 | CEA

Question 68

What is the tumor marker of Germ Cell Tumor

Answer 68

LDH hCG AFP

Question 69

What is the tumor marker of Granulosa-Theca Cell or Sertoli-Leydig cell

Answer 69

Estrogen, Testosterone

Question 70

[Ovarian CA Staging] Confined to ovaries of FT, with surgical spill

Answer 70

IC1

Question 71

[Ovarian CA Staging] Confined to ovaries or FT, ruptured before surgery

Answer 71

IC2

Question 72

[Ovarian CA Staging] confined to ovaries or FT, positive malignant cells in the peritoneal fluid

Answer 72

IC3

Question 73

[Ovarian CA Staging] pelvic extension or primary peritoneal cancer

Answer 73

Stage II

Question 74

[Ovarian CA Staging] spread to peritoneum outside the pelvis and metastasis to retroperitoneal LN

Answer 74

Stage III

Question 75

Most frequent ovarian epithelial tumor

Answer 75

Serous tumor

Question 76

___ CA that contains hobnail cells

Answer 76

clear cell

Question 77

What is the most common malignancy in women <30 years old

Answer 77

Germ Cell Tumor

Question 78

Most common malignant germ cell tumor

Answer 78

dysgerminoma

Question 79

What is the tumor marker of dysgerminoma?

Answer 79

LDH

Question 80

What is the tumor marker of Yolk Sac tumor or Endodermal sinus tumor?

Answer 80

AFP

Question 81

What is the tumor marker of choriocarcinoma?

Answer 81

hCG

Question 82

What is the tumor marker of Immature Teratoma?

Answer 82

AFP

Question 83

[Ovarian Tumor] functionally estrogenic

Answer 83

Granulosa Theca Cell Tumor

Question 84

[Ovarian Tumor] functionally testosterogenic

Answer 84

Sertoli Leydig Cell Tumor

Question 85

Most common benign tumor for <30 years old

Answer 85

dermoid

Question 86

Schiller-duvall bodies

Answer 86

Endodermal sinus/yolk sac tumor

Question 87

Call exner bodies

Answer 87

Granulosa-theca tumor

Question 88

Precocious puberty in children

Answer 88

granulosa-theca cell

Question 89

Nipple projections in dermoids

Answer 89

Tubercle of rokitansky

Question 90

Numerous hyaline droplets

Answer 90

Endodermal sinus/yolk sac tumor

Question 91

Tumor marker of Choriocarcinoma

Answer 91

HCG

Question 92

Tumor marker of dysgerminoma

Answer 92

LDH

Question 93

Analogous to seminoma in males

Answer 93

Sertoli-Leydig Tumor

Question 94

Composed of malignant syncitiotrophoblast and cytotrophoblast

Answer 94

Choriocarcinoma

Question 95

most common malignant tumor <30 years old

Answer 95

dysgerminoma