Primary and Secondary Prevention of Cervical Cancers Flashcards Preview

Life Cycles: Unit 1 > Primary and Secondary Prevention of Cervical Cancers > Flashcards

Flashcards in Primary and Secondary Prevention of Cervical Cancers Deck (18)
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1
Q

Major types of cervical epithelial cells

A
  • Ectocervix → Stratified, non keratinizing, squamous epithelium; abundant cytoplasm, dark pyknotic nucleus
  • Endocervix → Columnar, mucous secreting, epithelium; may appear in a “honeycomb” array, with distinct cell membranes due to cytoplasmic mucin.
2
Q

cells present?

A
  • top of image = mature squamous cells (ectocervix)
  • lower left corner = columnar glandular cells (endocervix)
3
Q

HPV virus types/risks

A
  • Warts: 6, 11 (low risk)
  • Dysplasia:16, 18, others (high risk)
  • Carcinoma: 16, 18, others (high risk)
4
Q

Squamous changes in cervical dysplasia

A
  • Spectrum of cervical intraepithelial neoplasia (CIN) from left to right:
  • Normal squamous epithelium for comparison;
  • CIN I with koilocytotic atypia;
  • CIN II with progressive atypia in all layers of the epithelium;
  • CIN III (carcinoma in situ) with diffuse atypia and loss of maturation.
5
Q

Benign cytology pap smear results and histologic appearance

A
  • Normal ==> Normal histology
  • ASC = Atypical squamous cells. ASC and more = Colposcopy ==> No direct translation on histo
  • ASC-H = Atypical squamous cells cannot exclude HSIL ==> No direct translation on histo
6
Q

Characteristics of LSIL on cytology pap smear results and histologic appearance

A
  • LSIL → Low grade squamous intraepithelial lesion
    • 50% will be normal
    • 40% will be CIN I
    • 10% will be CIN II - III
  • Usual histo appeareance: CIN I (1.4m)
7
Q

Characteristics of HSIL on cytology pap smear results and histologic appearance

A
  • HSIL → High grade squamous intraepithelial lesion
    • 30% will be normal
    • 30% will be CIN I
    • 30% will be CIN II - III
  • Usual histo = CIN II* - III* (330k)
8
Q

Most common histologic types of invasive cervical carcinoma

A
  • Squamous cell carcinoma - precursor CIN if HPV related
  • Cervical adenocarcinoma - precursor is adenocarcinoma in situ (AIS)
9
Q

Gardisil: antigenic components and viral types covered

A
  • Antigens
    • Quadrivalent L1 virus-like particle (VLP) - yeast
  • Viral types
    • HPV 6 / 11 / 16 / 18
10
Q

Cervarix: antigenic components and viral types covered

A
  • Bivalent virus like particle - yeast
  • 16, 18
11
Q

Gardisil: efficacy

A
  • Prophylactic efficacy of 98.8% in the reduction of genital warts, CIN 2, CIN 3 and adenocarcinoma in situ if woman is naive
  • previously exposed => overall reduction of 44 % in disease related to other HPV types
  • Males: Studies have demonstrated 90% efficacy in the prevention of external genital warts in males aged 16 – 23
12
Q

Cervarix: efficacy

A
  • Seroconversion to the HPV types included in the vaccine is 100% and protection against CIN 2 and 3 and adenocarcinoma caused by HPV types 16 and 18 is 93%.
  • Somehow gives better protection for another strain of HPV (31, 45) that causes cancer
13
Q

Provider impact on HPV vaccine administration

A
  • Most likely to recommend when providers have a positive attitude about the behavior, when they feel their opinion is supported by trusted colleagues and professional organizations, and when they feel they have control over its implementation.
  • Recommendation ↑ with age of patient, due to informed consent. Unfortunately, this ↓ efficacy if they become sexually active
14
Q

Parental impact on HPV vaccine administration

A
  • Mostly receptive
  • Biggest concern - “How will this affect my child’s sexual behavior?”
  • Regression - down to the rest of the population
  • Disinhibition - or even worse way too much sex.
  • Parents from highly eclectic, subgroups reported being less likely to vaccinate
15
Q

Young adults impact on HPV vaccine administration

A
  • Studies in this population find that HPV vaccination is generally well accepted.
  • One survey provided 340 college students with information about HPV found that
  • 75% of women and 33% of men would agree to a vaccination covering HPV 16 & 18.
  • Acceptance rates ↑ to 90% and 75% when coverage was broadened to include HPV 6 and 11.
  • The intention to receive the vaccine was greater among participants scoring higher on an HPV knowledge test and with more than five lifetime sexual partners.
16
Q

Issues involving vaccination (to HPV) in HIV positive

A
  • potential differences between vaccination strategies targeted at infants born with HIV and those who acquire it later in life.
  • The point in their HIV infection at which they are vaccinated
  • Preexisting exposure to HPV
  • Viral loads
  • CD 4 counts
  • The potential role of highly active antiretroviral therapy
17
Q

Trends in cervical cancer screening recommendations

A
  • Less screening
  • Start later
  • Screen less often
  • Eliminate certain groups entirely (pts who have undergone hysterectomy, >65y.o)
  • Add co-testing (cytology plus HPV)
18
Q

2009 recommendations for cervical cancer screening

A
  • Cervical cancer screening should begin at age 21 years.
    • Exception: HIV+
  • screening every 2 years for women between the ages of 21 and 29 years.
  • Women may extend the interval to every 3 years if the following are true:
    • They are ≥ 30 years of age
    • They have had three consecutive negative cervical cytology screening test results
    • They have no history of CIN 2/CIN 3
    • They are not HIV infected
    • They are not immunocompromised
    • They were not exposed to DES in utero.