Term
| what percent of women have never had cervical cytology |
|
Definition
|
|
Term
| what percent of women have not had cervical cancer screening in >5y |
|
Definition
|
|
Term
| HPV is associated with cancers where and the incidence |
|
Definition
vulva 50%
vaginal 50%
penile 40%
anal 90%
oropharyngeal 25% |
|
|
Term
| what percent of HPV are in the vaccine |
|
Definition
|
|
Term
| what percent of women will get HPV within 2y of coitarchie |
|
Definition
|
|
Term
| what type of virus is HPV |
|
Definition
| papovavirade family DS DNA |
|
|
Term
|
Definition
E6 - inhibits p53 (involved in apoptosis)
E7 - binds Rb (release E2F TF which causes cell proliferation) |
|
|
Term
| HPV 16/18 are associated with what percent of HPV cancers |
|
Definition
70% overall
16 - 60%
18 - 10% |
|
|
Term
| what are the #3 and #4 HPV that cause cancers and what percent |
|
Definition
|
|
Term
| what HPV cause 90% of condylomas |
|
Definition
|
|
Term
| what HPV cause verruca pantaris |
|
Definition
|
|
Term
| what HPV cause verruca vulgaris |
|
Definition
|
|
Term
| what HPV cause verruca plana |
|
Definition
|
|
Term
| when <21yo on average how long does it take to clear HPV |
|
Definition
|
|
Term
| what percent of HPV clear in 1 and 2y |
|
Definition
|
|
Term
| what is the risk of cancer in CIN3 |
|
Definition
|
|
Term
| what is the average time of CIN3 to cancer |
|
Definition
|
|
Term
| what percent of ASCUS will have CIN3 and cancer |
|
Definition
|
|
Term
| what percent of ASCH will have CIN 2-3 |
|
Definition
|
|
Term
| what percent of LSIL have high risk HPV subtypes on testing |
|
Definition
|
|
Term
| what percent of LSIL have CIN2-3 |
|
Definition
|
|
Term
| what percent of LSIL will regress |
|
Definition
|
|
Term
| what percent of LSIL will progress to cancer |
|
Definition
|
|
Term
| what percent of HSIL will have CIN2-3 |
|
Definition
|
|
Term
| risk factors for HPV infection |
|
Definition
| smoking, immune compormise, HIV, AA, hispanic, alcohol, more partners, early coitarchie, SLE, low SES, high parity, long term OCPs |
|
|
Term
| what type of cervical cancer do long term OCPs increase the risk of |
|
Definition
|
|
Term
| why do we cotest at >30yo |
|
Definition
<30yo detects too much transient HPV causing non-indicated procedures
better at detecting CIN 2 and cancer |
|
|
Term
| how should you biopsy on colpo |
|
Definition
| directed or 4 quad - 4 quad detects 25% of missed CIN |
|
|
Term
| how does acetic acid show HPV |
|
Definition
| desiccant reducing cytoplasm to enhance prominent nuclei causing acetowhite change |
|
|
Term
|
Definition
| stains glucogen which is lower in HPV causing non-stained areas |
|
|
Term
|
Definition
| mosacism, punctation, vascular changes on green filter |
|
|
Term
|
Definition
| acetyl white plaques, clear demacration, fine punctations, better seen with acetic acid |
|
|
Term
| signs of CIN 2-3 on colpo |
|
Definition
| dull white plaques, cobblestoning, coarse punctations, atypical vessles, mosacism |
|
|
Term
|
Definition
| no lesion on colpo, unsat colpo, prior ablation of TZ, lesion at TZ, ASCH, HSIL, ACG, AIS |
|
|
Term
|
Definition
<21yo no screening
21-29yo cytology q3y
>30yo cotesting q5y or cytology q3y
>65yo no screening |
|
|
Term
|
Definition
| >65yo and no history of CIN2+ for 20y and adequate screening (2 pap with cotest, 3 pap cytology alone one being in last 5y) |
|
|
Term
| why are there false positive paps after 65yo |
|
Definition
|
|
Term
| screening pap schedule post hysterectomy |
|
Definition
| DC if no CIN2+ for 20y and adequate screening (2 cotest or 3 cytology one being in last 5y) |
|
|
Term
| what is the risk of abnormal cuff cytology in someone who had CIN3 before hysterectomy |
|
Definition
|
|
Term
| how does CIN 2 correlate with HSIL/LSIL |
|
Definition
p16 negative - LSIL
p16 positive - HSIL |
|
|
Term
| what are the requirements for laser or cryo cervical ablation |
|
Definition
| exclusion of invasive cancer, has never had treatments before, negative ECC, adequate colposcopy |
|
|
Term
| what cervix treatment has lowest and highest risk of PTD |
|
Definition
laser - lowest
LEEP - 1.5x risk, 4.5%
CKC - 2.5x risk, 7.5% |
|
|
Term
| what is the recurrence after LEEP, laser, CKC |
|
Definition
leep = 13%
laser = 13#
CKC = 19% |
|
|
Term
| how deep does cervix laser ablation go |
|
Definition
|
|
Term
| other than PTD, what other pregnancy issues is cervical excision/ablation associated with - 3 |
|
Definition
| low birth rate, c-section, cervical stenosis 3% |
|
|
Term
| what do you do if someone has positive margins on LEEP |
|
Definition
|
|
Term
| what are the indications for a CKC |
|
Definition
| microinvasive disease, preference, AIS |
|
|
Term
| after hyst what percent will continue to have abnormal cytology if had pre-cancer lesion |
|
Definition
|
|
Term
| how does the HPV vaccine work |
|
Definition
| virus like particles in saccharomyces cervisiae, L1 proteins self assemble into virus like particles |
|
|
Term
| what is in the bivailent HPV vaccine, what is the cIN and cancer protection rate |
|
Definition
16, 18
CIN nearly 100%
cancer 30% |
|
|
Term
| what is in the quadrivalent HPV vaccine, waht is the CIN and cancer protection rate |
|
Definition
16, 18, 6, 11
cancer 30%
CIN nearly 100% |
|
|
Term
| what is in the 9 vailent HPV vaccine what is the cancer and CIN reduction rate |
|
Definition
16, 18, 6, 11, +5 more
cancer 50%
CIN nearly 100% |
|
|
Term
| who should get the HPV vaccine |
|
Definition
| 9-26yo males and females (generally 11-12yo), >26yo off label but can be indicated |
|
|
Term
| who should get the two dose HPV vaccine and who the three dose |
|
Definition
two dose - <15yo, interval between doses <5mo
three dose - all with immune suppression, everyone else, <15yo with >5mo break |
|
|
Term
| what should you do if someone misses a HPV vaccine dose |
|
Definition
| pick up where you left off |
|
|
Term
| contraindications to HPV vaccine |
|
Definition
| allergy to yeast, current pregnancy, safe in breast feeding, moderate to severe current febrile illness wait until after |
|
|
Term
| side effects of HPV vaccine |
|
Definition
pain 83%, swelling 25%, erythema 24%, pruritis 3%, fever 10%, nausea 4%, dizziness 2%
*placebo had same SE but approx 10% less for each, half the rate of the ones <10% initially |
|
|
Term
| what is the benifit of giving the HPV vaccine to patients who are already HPV positive |
|
Definition
| about 45% effective but can decrease progression |
|
|
Term
| how much more effective is the 9 vailent HPV vaccine then the others |
|
Definition
|
|
Term
| what strains are not covered unless your get the 9 vailent HPV vaccine |
|
Definition
52, 58 - not covered in direct or cross protection
they dont directly cover other types but do cross cover |
|
|
Term
| HPV vaccine prevents ___% anogenital warts |
|
Definition
|
|
Term
| what should you do with an unsat pap cytology, what if it is unsat HPV positive |
|
Definition
repeat in 2-4mo, if it happens again colpo
if HPV positve and <30yo routine screening
if HPV positive and >30yo colpo if recurs twice or if 16/18 positive |
|
|
Term
| what should you do if pap cytology returns not unsat, but insufficient/absent tZ, what if it is HPV positive |
|
Definition
routine screening
if HPV pos and <30yo routine screening
if HPV pos and >30yo colpo if 16/18 pos, cotest in 1y otherwise |
|
|
Term
|
Definition
| skip lesions, precursor for adenocarcinoma |
|
|
Term
| management of AIS - non-fertility sparing |
|
Definition
| cone to rule out other pathologies, extrafascial hyst regardless of margins |
|
|
Term
| management of AIS - fertility sparing |
|
Definition
cone neg margins neg ECC - colposcopy and cotesting q12mo
cone pos margins pos ECC - reexcision then cplpo and cotest q12mo |
|
|
Term
|
Definition
10% negative margins after cone
60% positive margins after cone |
|
|
Term
| rate of residual disease after cone in AIS |
|
Definition
negative margins 30%
positive margins 60% |
|
|
Term
| what are atypical glandular cells of the cervix associated with |
|
Definition
reactive changes
polyps
squamous dysplasia
adenocarcinoma of the cervix
adenocarcinoma of the endometrium, ovaries, tubes |
|
|
Term
| when someone has atypical glandular cells on pap what percent have CIN2+ and cancer |
|
Definition
|
|
Term
| what is the cause of atypical glandular cells (not the associated conditions) |
|
Definition
|
|
Term
| what do you do when you get atypical glandular cells on a pap now |
|
Definition
colposcopy WITH ECC
EMBx if >35yo or risk factors
HPV testing not indicated does not change management |
|
|
Term
| what do you do when you get a pap with benign glandular changes |
|
Definition
pre-menopause - nothing
post-menoause - EMBx
post-hyst - nothing |
|
|
Term
| what do you do when you get a pap with normal endometrial cells |
|
Definition
pre-menopause - nothing
post-menopause - EMBx
post-hyst - nothing |
|
|
Term
| after you do an excision or ablation of the cervix what is the follow up |
|
Definition
cotesting in 12 and 24mo then at 3y
if had positive margins do ECC at 4-6mo in addition |
|
|
Term
| who are considered high risk patients when it comes to cervical cancer screening |
|
Definition
| HIV, immune compormised, DES exposure in utero, history of CIN2+, history of cervical cancer |
|
|
Term
| cervical screening if history of DES exposure in utero |
|
Definition
|
|
Term
| cervical cancer screening for high risk patients |
|
Definition
cytology within 1y of sexual activity or 1y of diagnosis of risk factor
do not discontinue at 65yo
anal cytology at same time |
|
|
Term
| HIV cervical cancer screening |
|
Definition
<30yo - cytology yearly until 2 consecutive negative then cytology q3y
>30yo - cytology or cotesting, annual until 3 consecutive negative then q3y regardless of method
history of CIN 2-3: annual cotesting x2 then annual cytology |
|
|
Term
| when should someone with HIV get anal cytology |
|
Definition
| CD4 <200, history of STI other than HPV, current abnormal cervical cytology |
|
|
Term
| how is management of abnormal pap results different in HIV |
|
Definition
LSIL - directly to colposcopy
ASCUS >21yo - directly to colposcopy
ASCUS <21yo - cytology in 6mo
CIN 2+ - directly to excision or ablation |
|
|
Term
| what percent of pregnancies have cervical dysplasia |
|
Definition
|
|
Term
| what if you need to colpo during pregnancy |
|
Definition
you can wait until 6wk pp for ASCUS but its fine in pregnancy as long as no ECC, need to do if > ASCUS
limit biopsies to suspicious lesions only
if CIN2+ do colposcopy q12wk or defer to PP, repeat biopsy only if worsened lesion |
|
|
Term
| what are the criteria for expedited cryotherapy of the cervix in low resource settings |
|
Definition
| >75% of the cervix is positive on colpo, TZ is completely visualized, and there is no extension into the canal |
|
|
Term
| what is the success rate for early cryotherapy of the cervix in low resource settings |
|
Definition
| 80% success for CIN3 over 3y monitoring |
|
|
Term
| what are the types of cervical cancer and the incidence |
|
Definition
squamous cell 80%
adenocarcinoma 25%
adenosquamous
neuroendocrine 1-2% |
|
|
Term
| what are the typs of squamous cell cervix cancer |
|
Definition
squamous cell carcinoma 70% of all cervix cancers
large cell keratinizing
large cell non-keratinizing |
|
|
Term
| what are the types of adenocarcinomoa of the cervix |
|
Definition
adenocarcinoma
mucinous - common
endometroid - rare
clear cell - DES |
|
|
Term
| what are the types of adenosquamous cancer of the cervix |
|
Definition
malignant glandular
malignant squamous |
|
|
Term
| what the neuroendocrine carcinomas of the cervix |
|
Definition
small cell - most common neuroendocrine
large cell
typical carcinoid
atypical carcinoid |
|
|
Term
|
Definition
| bleeding, post coital spotting, AUB, PMP bleeding asymptoamtic, foul smelling yellowish discharge, back pain, lethargy, nausea, vomiting, fistula, leg swelling, renal failure |
|
|
Term
| how is cervix cancer stage 1 broken up |
|
Definition
1A1 - confined to cervix <3mm depth
1A2 - confined to cervix 3-5mm depth
1B1 - >5mm depth, <2cm dimension
1B2 - >5mm depth, <4cm dimension
1B3 - >4cm dimension |
|
|
Term
| how is cervical cancer stage 2 broken up |
|
Definition
2A1 - upper 2/3 vagina, <4cm
2A2 - upper 2/3 vagina, >4cm
2B - parametrial involvement |
|
|
Term
| how is cervical cancer stage 3 broken up |
|
Definition
3A - lower 1/3 vagina
3B - pelvic wall, hydronephrosis
3C1 - pelvic nodes
3C2 - paraaortic nodes |
|
|
Term
| how is cervical cancer stage 4 broken up |
|
Definition
4A- pelvic organs
4B - distant organs |
|
|
Term
| what stages of cervix cancer can undergo fertility sparing management |
|
Definition
|
|
Term
| what stages of cervical cancer require cone vs trachelectomy for fertility sparing management |
|
Definition
1A1 - cone
1A2 - either
1B1 - 1B2 - trachelecotmy |
|
|
Term
| what stages of cervical cancer are best treated with extrafascial hysterectomy |
|
Definition
|
|
Term
| what stages of cervical cancer are best treated with radical hysterectomy |
|
Definition
1A1 with LVSI
1A2
1B1
1B2
NOT 1B3
2A1 |
|
|
Term
| what stages of cervical cancer are best trreated with ERBT and cisplatin rather than hysterectomy |
|
Definition
|
|
Term
| if someone is a poor surgical candidate and they have cervical cancer what do you do |
|
Definition
| ERBT and brachytherapy +/- cisplatin |
|
|
Term
| what is the survival rate of stage 1A cervical cancer |
|
Definition
|
|
Term
| what is the survival of stage 1B cervical cancer |
|
Definition
|
|
Term
| what is the survival of stage 2 cervical cancer |
|
Definition
|
|
Term
| what is the survival of stage 3 and 4 cervical cancer |
|
Definition
|
|
Term
| when should you consider primary chemo rads rather than hyst for cervical cancer (characteristics not stage) |
|
Definition
| >4cm, positive nodes, positive margins, parametrial extension, stage IIB+ |
|
|
Term
| what are the citeria for fertility sparing management in cervical cancer |
|
Definition
<40yo
<2cm lesion
no upper endocervix extension
stage 1A with LVSI or 1A2 or 1B1
no evidence of nodal mets |
|
|
Term
| what is the recurrence date of cervical cancer after trachelectomy |
|
Definition
|
|
Term
| what is the risk of fetal loss after trachelectomy |
|
Definition
|
|
Term
|
Definition
| positive nodes, margins, parametria -> chemo rads after surgery |
|
|
Term
|
Definition
| evaluates stromal invasion, tumor size, LVSI to determine if chemo rads after surgery |
|
|
Term
| what is the risk of nodal mets in 1A1 cervix cancer |
|
Definition
|
|
Term
| what is the risk of nodal mets in 1A2 cervix cancer |
|
Definition
|
|
Term
| what is the best way to look at nodes in cervix cancer |
|
Definition
|
|
Term
| how does LVSI and microinvasive perdict nodal meds in cervix cancer |
|
Definition
| microinvasion not associated unless LVSI, LND is not required for microinvasion |
|
|
Term
| what are the 1st nodes involved in cervix cancer |
|
Definition
|
|
Term
| what is a modified radical hysterectomy |
|
Definition
| 1-2cm vagina, 1-2cm parametria, 1-2cm rectouterine |
|
|
Term
| what is a radical hysterectomy |
|
Definition
| 1/3 vagina, parametria to internal iliacs, rectouterine 2cm |
|
|
Term
| what is a simple trachelectomy |
|
Definition
| leave 5mm cervix for cerclage, resect parametria to cervix border, divide rectouterine at cervix border |
|
|
Term
| what is a radical trachelectomy |
|
Definition
| leave 5mm of cervix for cerclage, resect 1-2cm vagina, unroof urethra from cervix, resect parametria to ureter, resect 1-2cm rectouteirne |
|
|
Term
| what are the risks and incidence of them for radical hysterectomy |
|
Definition
| bladder dysfunction 10%, ureter injury <2%, bladder injury <1%, fistula <1%, PE, blood transfusion |
|
|
Term
| what are the risks of pelvix exenteration |
|
Definition
5% mortality
40% complication - hemorrhage, infection, abscess, SBO, fistula
high EBL 1-3L |
|
|
Term
| poor prognostic factors associated with pelvic exenteration |
|
Definition
| chemo within last 2y, positive paraaortic nodes, smokers, >70yo, primary site of disease, time to recurrence |
|
|
Term
| benifit of chemo in cervical cancer |
|
Definition
| 30-50% decreased risk of death |
|
|
Term
| benifit of bevacizumab in cervical cancer |
|
Definition
| 4mo survival advantage, higher response rate to chemo |
|
|
Term
| response rate to cisplatin in cervix cancer |
|
Definition
|
|
Term
| borders for radiation in cervix cancer |
|
Definition
16x16cm
L4-5
1cm lateral to bony pelvis
obturator foramen
covers internal and external iliac nodes |
|
|
Term
| surveillance in fertility sparing cervical cancer patients |
|
Definition
stage 1- imaging based on symptoms, 1B3 and had adjuvant chemo rads then PET q3-6mo
stage 2+ - PET and MRI 3-6mo after therapy |
|
|
Term
| contraindications to fertility sparing treatment, other than staging, for cervix cancer |
|
Definition
| neuroendocrine tumors, gastric type adenocarcinoma, adenoma maligum |
|
|
Term
| how is invasive cancer treated in pregnancy if desires to keep pregnancy |
|
Definition
can do CKC
chemo is ok
radical trachelectomy can be done - only a few cases
can have SVD if no visible tumor
1B1 - rad hyst at time of lung maturity or CKC
1B2-2 - CD after lung maturity then chemo/rads
2B-4A - CD after lung maturity, chemo during pregnancy
4B - pallative systemic chemo |
|
|
Term
| how is invasive cancer treated in pregnancy if desires to terminate pregnancy |
|
Definition
<24wk 1B-2A - rad hyst and nodes with fetus in situ
<24wk 2B-4A - pelvic ERBT and chemo |
|
|
Term
| surveillence after survical cancer |
|
Definition
q3-6mo for 2y, q6-12mo for 3-5y then annual visits
cytology annually
imaging based on symptoms, PET best, some say annual CXR |
|
|
Term
| risks for rrecurrence of cervical cancer |
|
Definition
stromal invasion >15mm
LVSI
tumor >4cm |
|
|
Term
| when do cervical cancers recur |
|
Definition
|
|
Term
| where do cervical cancers recur |
|
Definition
local - vaginal apex
regional - pelvic sidewall
distant - #1 nodes |
|
|
Term
| management of small cell cervix cancer |
|
Definition
rad hyst with LND if early stage
cistplatin etoposide if 1B+ |
|
|
Term
| poor prognostic signs in small cell cervix vancer |
|
Definition
early hematogenous dissemination
LVSI and nodal mets
large tumor
advanced stage
pure small cell histology |
|
|
Term
| what percent of small cell cervix cancer will have nodal mets |
|
Definition
|
|
Term
| 5y survival small cell cervix cancer |
|
Definition
| 11-50%, 30% if limited to pelvis |
|
|
Term
|
Definition
|
|
Term
| #1 GYN cancer in the world |
|
Definition
|
|
Term
| what do you do if not meeting criteria for expedited cryo in a low resource setting |
|
Definition
|
|
Term
| how much is cervical cancer decreased by expedited cryo in low resource settings |
|
Definition
|
|
Term
| ASCUS to HSIL - risk of CIN2+ |
|
Definition
| ASCUS- 0.04, NILM- 0.08, NILM+ 2.6, ASCUS+ 7, NILM++ 10, LSIL 28, ASCH 40, HSIL 60 |
|
|
Term
| what is the screening schedule for DES exposure |
|
Definition
| yearly cytology starting at 21yo |
|
|
Term
| what is the screening schedule for someone who had CIN2+ before |
|
Definition
|
|
Term
| what is the screening schedule for HIV <30yo - no abnormal history |
|
Definition
| yearly cytology x3y then cytology q3y |
|
|
Term
| what is the screening schedule for HIV >30yo - no abnormal history |
|
Definition
| yearly contesting x3y then contesting q3y |
|
|
Term
| what is the screening schedule for HIV with history of CIN2+ |
|
Definition
| contesting x2y then cytology yearly |
|
|
Term
| indications for anal cytology - 5 |
|
Definition
| CD4 <200, HIV with STI, abnormal cervix cytology (esp high grade), hx of vulvar/cervical cancer, other immune compormise |
|
|
Term
| cervix treatments from lowest to highest risk of PTD |
|
Definition
| laser < cryo < LEEP < CKC |
|
|
Term
|
Definition
| no visible lesions, prior cryo/LEEP, cant see TZ, lesion at TZ, ASCH, HSIL, AIS, AGS |
|
|
