4 Cervical cancer – Flashcards

question
How many new cases of cervical cancer there are in Australia per year:
answer
1000
question
How many deaths from cervical cancer there are in Australia per year:
answer
250
question
Cervical cancer is the ___ most common cancer in women worldwide each year
answer
4th
question
Most common cancer in women worldwide: Number 1) =
answer
breast
question
Most common cancers in women worldwide: Number 2) =
answer
colorectal
question
Most common cancers in women worldwide: Number 3) =
answer
lung
question
Most common cancer in women worldwide: Number 4) =
answer
cervical
question
A pre-neoplastic condition of the cervix = cervical _____
answer
dysplasia
question
Whether cervical dysplasia progresses to carcinogenesis, depends on: - persistent ____ infection - host ____ status
answer
HPV, immune
question
Chance of surviving at least 5 years after cervical cancer diagnosis in Australia =
answer
70%
question
The number of new cases of cervical cancer diagnosed each year, in the last 20 years, has: (increased or decreased)
answer
decreased
question
Cervical cancer prevalence - developed or developing world?
answer
developing
question
renewed National Cervical Screening Program will invite women aged ____ to ___ years, both HPV vaccinated and unvaccinated, to undertake an HPV test every 5 years
answer
25, 74
question
renewed National Cervical Screening Program will invite women aged 25 to 74 years to undertake an ____ test every 5 years
answer
HPV
question
renewed National Cervical Screening Program will invite women aged 25 to 74 years to undertake an HPV test every ___ years
answer
5
question
Will both vaccinated and unvaccinated women have HPV tests in the new program?
answer
yes
question
Does a Papsmear test for the HPV virus?
answer
no (looks at abnormal cells)
question
Current Papsmear program: for ages ___ to 69
answer
18
question
True/false: Papsmears have a lot of false positives and negatives.
answer
True
question
Benefit of cervical cancer screening:
answer
decreased incidence
question
True/false: HPV has a viral envelope
answer
False
question
True/false: HPV is a DNA virus
answer
True
question
HPV virus = DNA or RNA?
answer
DNA
question
70% of cervical cancer is due to these strains of HPV
answer
16, 18
question
True/false: HPV is needed for cervical cancer
answer
True
question
Cervical cancer screening: The current program recommends ____-yearly Pap tests for women aged 18-70 who are or have ever been sexually active.
answer
2
question
Cervical cancer screening: Under the new program, women aged 25-74 will be tested for ____ every ____ years.
answer
HPV, 5
question
Who are the people that get cervical cancer nowadays? Those who lapsed the
answer
screening
question
Changing cervical cancer screening, to a ____ test every ___ years
answer
HPV, 5
question
If a patient tests HPV+ after a sample has been taken and tested, next step =
answer
cytology
question
At what age is cervical screening going to start with the new program? At age
answer
25
question
Worldwide, new diagnoses of cervical cancer per year =
answer
500,000
question
Aetiology of cervical caner 1) ______ infection with oncogenic ___
answer
persistent HPV
question
HPV causes which cancer?
answer
cervical
question
True/false: 99.7% of cervical cancers test positive for HPV
answer
True
question
Is persistent HPV always going to cause cancer?
answer
no (cofactors)
question
#1 co-factor associated with cervical cancer i.e. need persistent HPV infection PLUS co-factor =
answer
smoking
question
Co-factors that contribute to cervical cancer risk - s_____ - long-term ____ use - ____ co-infection - high p_____
answer
smoking, OCP, HIV, parity
question
True/false: HPV cancer is associated with oropharyngeal cancer.
answer
True
question
Genital warts, caused by HPV strains (2)
answer
6, 11
question
Most HPV infections are transient and are eliminated by the immune response in the course of _____ (days, months, years)
answer
months
question
HPVs infect immature ______ cells of the squamous epithelium in areas of epithelial breaks
answer
basal
question
Most HPVs infect the ___
answer
skin
question
CIN, is also known as
answer
cervical dysplasia
question
True/false: Most types of HPV do not cause any symptoms and go away on their own.
answer
True
question
About ___ (number) HPV infections affect the genital area
answer
40
question
__% Australians will be affected with HPV of some type at some point in their lives
answer
80%
question
True/false: HPV infection could almost be considered a normal part of being sexually active.
answer
True
question
Main route of transmission of HPV
answer
sexual intercourse
question
a test that can detect abnormal cells in the cervix that may lead to cervical cancer
answer
Papsmear
question
CIN grades cervical ____
answer
dysplasia
question
Cervical dysplasia grading system = _ _ _
answer
CIN
question
CIN grading, 1 to ___
answer
3
question
HPV is a ___ virus, approx. _____ base pairs
answer
DNA, 8000
question
HPV, over ____ different genotypes
answer
200
question
Oncogenes of HPV, = (2)
answer
E6, E7
question
an examination of the cervix with a special microscope
answer
colposcopy
question
HPV >> precancerous lesions increase the risk of cancer of the c_____, v_____; also in males: p_____, + o_______
answer
cervical, vagina, penis, oropharynx
question
The late region of the HPV genome, encodes for the ____ proteins
answer
capsid
question
The early region of the HPV genome, encodes for ________ proteins
answer
non-structural
question
The E in E6 and E7 stands for ____ genes
answer
early
question
True/false: HPV can integrate into the host cell genome
answer
True
question
E6 binds and degrades this TSG
answer
p53
question
The ectocervix, epithelium =
answer
stratified squamous
question
The endocervix, epithelium =
answer
columnar
question
The columnar epithelium endocervix secrets
answer
mucus
question
HPV enters through a micro-abrasion and infects - which cells ?
answer
basal cells
question
True/false: most HPV infection is naturally cleared within 1-2 years
answer
True
question
If there is persistent HPV infection, ______ integrate with the host's DNA
answer
episomes
question
extra-chromosomal genetic material that may become integrated into the chromosome or replicate autonomously
answer
episome
question
When does cervical dysplasia become cervical cancer? When it has _____ the ____ _____
answer
invaded, basement membrane
question
2 types of HPV vaccination
answer
Gardasil, Cervarix
question
Cervarix vaccine, strains = HPV __ and __
answer
16, 18
question
Gardasil vaccines, strains = HPV (4)
answer
16, 18, 6, 11
question
True/false: we are vaccinating girls and boys in Australia
answer
True
question
___ proteins: form the VLP for the vaccine
answer
L1
question
L1 proteins for _ _ _s for the vaccines
answer
VLP
question
% of infected women have no measurable anti-HPV antibody response after the infection
answer
50%
question
Which is a bigger virus; HPV or HBV?
answer
HPV
question
Two types of viruses; = _ _ _ or _ _ _
answer
DNA, RNA
question
Why is there high rates of cervical cancer in the developing world? Lack of
answer
screening
question
How many cervical cancer - related deaths are there worldwide per year?
answer
250000
question
% of cervical cancer is due to HPV 16 or 18
answer
70%
question
Genital and skin warts, caused by which family of viruses?
answer
HPV
question
The major bacterial promoter of cancer =
answer
helicobacter pylori (5% global cancer burden)
question
>100 HPV genotypes cause ____ infections
answer
skin
question
Cervical lesions are visualised and determined grading after application of ____ _____
answer
acetic acid
question
What colour do pre-cancerous cells look during colposcopy after application of acetic acid?
answer
white
question
Aim of cervical screening... to detect _________
answer
precancer
question
Aim of ________... to detect precancer
answer
screening
question
HSIL, CIN 2 or 3 = ___% chance of getting cervical cancer in the next 15 years
answer
30%
question
Abnormal Papsmear: high ____ to ____ ratio
answer
nucleus, cytoplasm
question
True/false: CIN diagnosis based on Papsmear
answer
False
question
True/false: CIN diagnosis requires a biopsy
answer
True
question
CIN grading is based on ______ of epithelial epithelium involved
answer
depth
question
Papsmear = abnormal. Next - what is required?
answer
biopsy
question
What technique visualises the cervix?
answer
colposcopy
question
Squamous cell carcinoma (skin) Immunosuppression may contribute to carcinogenesis by reducing host surveillance and increasing the susceptibility of keratinocytes to infection and transformation by oncogenic viruses, particularly _ _ _ subtypes _ and _
answer
HPV, 5, 8
question
Pre-malignant scaly skin lesions Rare AR disorder Abnormal susceptibility to HPV 5 and 8
answer
epidermodysplasia verruciformis
question
Patients with a rare autosomal recessive condition, epidermodysplasia verruciformis, which is marked by a high susceptibility to cutaneous squamous cell carcinomas HPVs infect these patients = __ and __ strains
answer
5, 8
question
epidermodysplasia verruciformis, prone to _ _ _ cancers
answer
SCC
question
Tonsil cancer, 50% are due to _ _ _ infection, strain = ___
answer
HPV, 16
question
Papillomaviruses, DNA or RNA?
answer
DNA
question
In CIN3, which genes are expressed by the cervical epithelium?
answer
E6, E7
question
True/false: 95% of CIN1 regresses to normal epithelium
answer
True
question
CIN1 has which viral proteins expressed by the surface epithelium?
answer
L1, L2
question
A tumour promotor, HPV infection PLUS ______ = increases risk of cervical carcinogenesis
answer
smoking
question
True/false: smoking is a protective factor against cervical cancer
answer
False
question
True/false: viral HPV DNA is integrated into the genome
answer
True
question
E6 activates this enzyme inducing immortality
answer
telomerase
question
E6 binds to ____ causing its degradation
answer
p53
question
E7 binds to _____ causing its degradation
answer
pRb
question
pRb usually inhibits ______
answer
E2F
question
pRb = a ___ ___ gene
answer
tumour suppressor
question
The papillomavirus capsid is made of ___ pentamers of __ protein
answer
72, L1
question
Viral protein of HPV that targets p53
answer
E6
question
Viral protein of HPV that targets pRb
answer
E7
question
When did the HPV vaccine program start, in ____
answer
2007
question
Cervical cancer in Australia = common or uncommon?
answer
uncommon
question
Cervical cancer globally = common or uncommon?
answer
common
question
True/false: often a person is asymptomatic until they have a bulky cervical cancer
answer
True
question
Known risk factors of cervical cancer - ___ coitarche (early or late?)
answer
early
question
Known risk factors of cervical cancer - multiple or few sexual partners?
answer
multiple
question
True/false: a known risk factor of cervical cancer is low SES.
answer
True
question
True/false: smoking is a known risk factor of cervical cancer
answer
True
question
Most common clinical presentation of a cervical cancer lesion
answer
asymptomatic
question
A common clinical presentation of cervical cancer: _____ bleeding
answer
postcoital
question
Staging of cervical cancer, ____ staging
answer
FIGO
question
FIGO staging of cervical cancer, is it "surgical" or "clinical"
answer
clinical
question
How many stages of cervical cancer are there in FIGO staging?
answer
4
question
Stage 1 FIGO cervical cancer = _______ to the ______
answer
confined, cervix
question
Stage 2 FIGO cervical cancer = ______ spread
answer
local
question
Is CT and MRI used for staging in cervical cancer?
answer
no
question
Can cystoscopy be used for staging in cervical cancer?
answer
yes
question
Can an intravenous pyleogram be used for staging in cervical cancer?
answer
yes
question
IVP in staging for cervical cancer - what are you looking for?
answer
hydronephrosis
question
Can a PET scan be used for staging in cervical cancer?
answer
no
question
Can a CXR be used for staging in cervical cancer?
answer
yes
question
Bladder and bowel involved, which stage of cervical cancer (FIGO)?
answer
4
question
A cervical cancer involves the pelvic side wall. What stage of cervical cancer (FIGO)?
answer
3 (B)
question
True/false: cervical cancer has a predictable natural history
answer
True
question
Most common pattern of spread in cervical cancer, via the
answer
lymphatics
question
Early stage cervical cancer, is Stage __ __
answer
1B
question
Stage 1B cervical cancer is considered "_____" cervical cancer
answer
early
question
2 treatment options for Stage 1B cervical cancer
answer
radiation, surgery
question
A cervical cancer that is big enough you can see it, but it hasn't spread to adjacent vagina or parametrium, Stage =
answer
1B
question
Surgery or radiation? , therapy options for treating cervical cancer Advantage = preserves sexual function
answer
surgery
question
Surgery or radiation? , therapy options for treating cervical cancer Disadvantage = vagina shortens, atrophies away and dilators are required
answer
radiation
question
Surgery or radiation? , therapy options for treating cervical cancer >> preserves ovarian function
answer
surgery
question
Surgery or radiation? , therapy options for treating cervical cancer Disadvantage = ovaries go
answer
radiation
question
Surgery or radiation? , therapy options for treating cervical cancer >> suitable for all stages of the disease
answer
radiation
question
Surgery or radiation? , therapy options for treating cervical cancer >> gives accurate assessment of the extent of disease
answer
surgery
question
Can radiation be a primary treatment for Stage 1B cervical cancer?
answer
yes
question
Can surgery be a primary treatment for Stage 1B cervical cancer?
answer
yes
question
Primary radiation therapy, 2 modalities a) _____ beam b) b________
answer
external, brachytherapy
question
The source of gamma radiation used in brachytherapy
answer
iridium 92
question
Radiation therapy for treating Stage 1B cervical cancer Give with concurrent ________
answer
chemotherapy
question
Chemotherapy agent given on first day of radiation therapy (treating cervical cancer)
answer
cisplatin
question
radiation therapy administered at a distance from the body =
answer
teletherapy
question
radiation therapy in which the source of radiation is implanted in the tissue to be treated =
answer
brachytherapy
question
Stage 1A cervical cancer is _______
answer
<3 mm
question
How to treat Stage 1A cervical cancer
answer
cone biopsy
question
Primary surgery treatment for Stage 1B and 2A cervical cancer =
answer
radical hysterectomy
question
Role of lymphadenectomy in early stage cervix; - is it "therapeutic"?
answer
no
question
Role of lymphadenectomy in early stage cervix; - to see whether ____ is needed
answer
radiation
question
Complication of lymphadenectomy in treating cervical cancer
answer
lymphoedema
question
surgery to remove the cervix, the upper part of the vagina and lymph nodes in the pelvis
answer
radical trachelectomy
question
The fertility-sparing surgery option in treating cervical cancer
answer
radical trachelectomy
question
This operation cuts out the cervix and attaches the uterus to the vagina
answer
radical trachelectomy
question
radical trachelectomy, associated with ______ births
answer
preterm
question
Adjuvant treatment in cervical therapy, when ____ ____ are positive
answer
lymph nodes
question
The chemotherapy agent used with radiation therapy in cervical cancer is ______-containing chemo
answer
platinum
question
platinum complexes react in the body, binding to DNA and causing the DNA strands to crosslink >> apoptosis Chemo drug =
answer
cisplatin
question
Why is chemotherapy used concurrently with radiation therapy for cervical cancer? As a
answer
radiation sensitiser
question
Late-stage cervical cancer, stages ___ to ___
answer
2B, 4
question
For recurrent disease in cervical cancer, the treatment is
answer
radiation
question
lined by columnar epithelium that secretes mucus Ectocervix or endocervix
answer
endocervix
question
covered by nonkeratinizing, stratified squamous epithelium, either native or metaplastic Ectocervix or endocervix
answer
ectocervix
question
the boundary between the ectocervix and endocervix meet
answer
squamocolumnar junction
question
area between original SC junction and new SC junction due to regenerative metaplastic response
answer
transformation zone
question
a luminal cavity within the cervix forming a passageway between the external os and the internal os
answer
endocervix
question
The ectocervix is covered by ____-_______, _____ _______ epithelium, either native or metaplastic in continuity with the vaginal epithelium
answer
non-keratinizing, stratified squamous
question
one layer of mucin secreting cells line the _______ (part of the cervix)
answer
endocervix
question
The SCJ is the result of a continuous ________ process resulting from uterine growth, cervical enlargement and hormonal status
answer
remodeling
question
At birth and during pre-menarchal years, the SCJ is located at or very close to the ____ _____ (original SCJ)
answer
external os
question
Progressively through a process called _______ the transformation zone is replaced by squamous epithelium
answer
metaplasia
question
Area between the original SCJ and the new SCJ where the columnar epithelium has been replaced by the new metaplastic squamous epithelium
answer
transformation zone
question
Is the Papsmear a reliable test?
answer
no
question
Which is easier to read for diagnosis - Papsmear or liquid-based cytology?
answer
liquid-based cytology
question
Abnormal cytologic changes of squamous epithelial cells = (esp in cervical cancer) = called:
answer
dyskaryosis
question
Can CIN be diagnosed on a Papsmear?
answer
no
question
dyskaryosis is synonymous with
answer
dysplasia
question
Suspicious Papsmear.... what technique we do next?
answer
colposcopy
question
Benign finding in the transformation zone = blocked cervical gands >> glandular tissue metaplasia and gland cells underneath become cysts
answer
Nabothian cysts
question
a mucus-filled cyst on the surface of the cervix = _____ cyst
answer
Nabothian
question
Is Nabothian cyst pathological?
answer
no
question
What colposcopy can tell us: s____, l_____, t_____ Is it accurate?
answer
size, location, topography, no
question
What should you always get when you're doing colposcopy?
answer
biopsy
question
3 treatment options for cervical dysplasia (L___, L____, c_____)
answer
laser, LEEP, cone
question
An approach to treat high grade cervical dysplasia discovered on colposcopic examination: a wire loop through which an electric current is passed
answer
LEEP
question
An approach to treat cervical dysplasia discovered on colposcopic examination: BURN it = using a
answer
laser
question
An approach to treat high grade cervical dysplasia - an excision =
answer
cone
question
laser, LEEP, cone = 3 treatment options for ______ _____ that is discovered on colposcopy
answer
cervical dysplasia
question
Two types of growth patterns of a cervical cancer =
answer
exophytic (cauliflower), endocervical
question
Is CT, PET and MRI used for staging in cervical cancer?
answer
no
question
Stage 1A, <___ mm tumour size and ____ to the cervix
answer
3, confined
question
If clinically-visible AND confined to the cervix = Stage ____
answer
1B
question
if tumour has spread to the vagina, but not the pelvic side wall, Stage ___
answer
2A
question
Stage 4 cervical cancer = which organs may be involved? (2)
answer
bladder, rectum
question
In the transformation zone, which epithelium "migrates"?
answer
columnar
question
Transformation zone: When the columnar epithelium migrates outwards and is converted back into squamous epithelium =
answer
metaplasia
question
HPV integrates into the cells and causes cervical _____
answer
dysplasia
question
CIN grading of dysplasia depends on the _____ of the epithelium involved
answer
thickness
question
Main cancers of the cervix (2)
answer
squamous cell carcinoma, adenocarcinoma
question
When is chemoradiotherapy going to be the primary treatment for cervical cancer? When the cancer is
answer
too big (to remove surgically)
question
Why do we do an EUC in the work-up for cervical cancer? >> the cancer may have spread to the pelvic ___ ____ and could be obstructing the _____
answer
side wall, ureter
question
Acute renal failure in a patient with Stage 4 cervical cancer, due to tumour obstructing the
answer
ureter
question
True/false: renal function needs to be good for radiotherapy
answer
.True
question
Aim of Stage 1B radiation therapy: ______ (cervical cancer)
answer
cure
question
Dose needed to cure cervical cancer = ____ Gray
answer
80
question
Radiation dose is limited by the surrounding tissue; in cervical cancer, what is at risk if you give radiation over 40 Gray?
answer
small bowel
question
Intrauterine _____ delivers half the dose of radiation therapy in treatment of cervical cancer
answer
brachytherapy
question
Acute effects of EBRT, due to ______ of surrounding tissues
answer
inflammation
question
Common organs affected acutely in radiation therapy of cervical cancer (2)
answer
bladder, bowel
question
Long-term side effect of radiation therapy in cervical cancer = i_____
answer
infertility
question
Late side effects of radiation therapy (EBRT) is due to s_____
answer
scarring
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question
How many new cases of cervical cancer there are in Australia per year:
answer
1000
question
How many deaths from cervical cancer there are in Australia per year:
answer
250
question
Cervical cancer is the ___ most common cancer in women worldwide each year
answer
4th
question
Most common cancer in women worldwide: Number 1) =
answer
breast
question
Most common cancers in women worldwide: Number 2) =
answer
colorectal
question
Most common cancers in women worldwide: Number 3) =
answer
lung
question
Most common cancer in women worldwide: Number 4) =
answer
cervical
question
A pre-neoplastic condition of the cervix = cervical _____
answer
dysplasia
question
Whether cervical dysplasia progresses to carcinogenesis, depends on: - persistent ____ infection - host ____ status
answer
HPV, immune
question
Chance of surviving at least 5 years after cervical cancer diagnosis in Australia =
answer
70%
question
The number of new cases of cervical cancer diagnosed each year, in the last 20 years, has: (increased or decreased)
answer
decreased
question
Cervical cancer prevalence - developed or developing world?
answer
developing
question
renewed National Cervical Screening Program will invite women aged ____ to ___ years, both HPV vaccinated and unvaccinated, to undertake an HPV test every 5 years
answer
25, 74
question
renewed National Cervical Screening Program will invite women aged 25 to 74 years to undertake an ____ test every 5 years
answer
HPV
question
renewed National Cervical Screening Program will invite women aged 25 to 74 years to undertake an HPV test every ___ years
answer
5
question
Will both vaccinated and unvaccinated women have HPV tests in the new program?
answer
yes
question
Does a Papsmear test for the HPV virus?
answer
no (looks at abnormal cells)
question
Current Papsmear program: for ages ___ to 69
answer
18
question
True/false: Papsmears have a lot of false positives and negatives.
answer
True
question
Benefit of cervical cancer screening:
answer
decreased incidence
question
True/false: HPV has a viral envelope
answer
False
question
True/false: HPV is a DNA virus
answer
True
question
HPV virus = DNA or RNA?
answer
DNA
question
70% of cervical cancer is due to these strains of HPV
answer
16, 18
question
True/false: HPV is needed for cervical cancer
answer
True
question
Cervical cancer screening: The current program recommends ____-yearly Pap tests for women aged 18-70 who are or have ever been sexually active.
answer
2
question
Cervical cancer screening: Under the new program, women aged 25-74 will be tested for ____ every ____ years.
answer
HPV, 5
question
Who are the people that get cervical cancer nowadays? Those who lapsed the
answer
screening
question
Changing cervical cancer screening, to a ____ test every ___ years
answer
HPV, 5
question
If a patient tests HPV+ after a sample has been taken and tested, next step =
answer
cytology
question
At what age is cervical screening going to start with the new program? At age
answer
25
question
Worldwide, new diagnoses of cervical cancer per year =
answer
500,000
question
Aetiology of cervical caner 1) ______ infection with oncogenic ___
answer
persistent HPV
question
HPV causes which cancer?
answer
cervical
question
True/false: 99.7% of cervical cancers test positive for HPV
answer
True
question
Is persistent HPV always going to cause cancer?
answer
no (cofactors)
question
#1 co-factor associated with cervical cancer i.e. need persistent HPV infection PLUS co-factor =
answer
smoking
question
Co-factors that contribute to cervical cancer risk - s_____ - long-term ____ use - ____ co-infection - high p_____
answer
smoking, OCP, HIV, parity
question
True/false: HPV cancer is associated with oropharyngeal cancer.
answer
True
question
Genital warts, caused by HPV strains (2)
answer
6, 11
question
Most HPV infections are transient and are eliminated by the immune response in the course of _____ (days, months, years)
answer
months
question
HPVs infect immature ______ cells of the squamous epithelium in areas of epithelial breaks
answer
basal
question
Most HPVs infect the ___
answer
skin
question
CIN, is also known as
answer
cervical dysplasia
question
True/false: Most types of HPV do not cause any symptoms and go away on their own.
answer
True
question
About ___ (number) HPV infections affect the genital area
answer
40
question
__% Australians will be affected with HPV of some type at some point in their lives
answer
80%
question
True/false: HPV infection could almost be considered a normal part of being sexually active.
answer
True
question
Main route of transmission of HPV
answer
sexual intercourse
question
a test that can detect abnormal cells in the cervix that may lead to cervical cancer
answer
Papsmear
question
CIN grades cervical ____
answer
dysplasia
question
Cervical dysplasia grading system = _ _ _
answer
CIN
question
CIN grading, 1 to ___
answer
3
question
HPV is a ___ virus, approx. _____ base pairs
answer
DNA, 8000
question
HPV, over ____ different genotypes
answer
200
question
Oncogenes of HPV, = (2)
answer
E6, E7
question
an examination of the cervix with a special microscope
answer
colposcopy
question
HPV >> precancerous lesions increase the risk of cancer of the c_____, v_____; also in males: p_____, + o_______
answer
cervical, vagina, penis, oropharynx
question
The late region of the HPV genome, encodes for the ____ proteins
answer
capsid
question
The early region of the HPV genome, encodes for ________ proteins
answer
non-structural
question
The E in E6 and E7 stands for ____ genes
answer
early
question
True/false: HPV can integrate into the host cell genome
answer
True
question
E6 binds and degrades this TSG
answer
p53
question
The ectocervix, epithelium =
answer
stratified squamous
question
The endocervix, epithelium =
answer
columnar
question
The columnar epithelium endocervix secrets
answer
mucus
question
HPV enters through a micro-abrasion and infects - which cells ?
answer
basal cells
question
True/false: most HPV infection is naturally cleared within 1-2 years
answer
True
question
If there is persistent HPV infection, ______ integrate with the host's DNA
answer
episomes
question
extra-chromosomal genetic material that may become integrated into the chromosome or replicate autonomously
answer
episome
question
When does cervical dysplasia become cervical cancer? When it has _____ the ____ _____
answer
invaded, basement membrane
question
2 types of HPV vaccination
answer
Gardasil, Cervarix
question
Cervarix vaccine, strains = HPV __ and __
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16, 18
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Gardasil vaccines, strains = HPV (4)
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16, 18, 6, 11
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True/false: we are vaccinating girls and boys in Australia
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True
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___ proteins: form the VLP for the vaccine
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L1
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L1 proteins for _ _ _s for the vaccines
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VLP
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% of infected women have no measurable anti-HPV antibody response after the infection
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50%
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Which is a bigger virus; HPV or HBV?
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HPV
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Two types of viruses; = _ _ _ or _ _ _
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DNA, RNA
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Why is there high rates of cervical cancer in the developing world? Lack of
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screening
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How many cervical cancer - related deaths are there worldwide per year?
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250000
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% of cervical cancer is due to HPV 16 or 18
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70%
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Genital and skin warts, caused by which family of viruses?
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HPV
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The major bacterial promoter of cancer =
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helicobacter pylori (5% global cancer burden)
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>100 HPV genotypes cause ____ infections
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skin
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Cervical lesions are visualised and determined grading after application of ____ _____
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acetic acid
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What colour do pre-cancerous cells look during colposcopy after application of acetic acid?
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white
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Aim of cervical screening... to detect _________
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precancer
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Aim of ________... to detect precancer
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screening
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HSIL, CIN 2 or 3 = ___% chance of getting cervical cancer in the next 15 years
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30%
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Abnormal Papsmear: high ____ to ____ ratio
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nucleus, cytoplasm
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True/false: CIN diagnosis based on Papsmear
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False
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True/false: CIN diagnosis requires a biopsy
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True
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CIN grading is based on ______ of epithelial epithelium involved
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depth
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Papsmear = abnormal. Next - what is required?
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biopsy
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What technique visualises the cervix?
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colposcopy
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Squamous cell carcinoma (skin) Immunosuppression may contribute to carcinogenesis by reducing host surveillance and increasing the susceptibility of keratinocytes to infection and transformation by oncogenic viruses, particularly _ _ _ subtypes _ and _
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HPV, 5, 8
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Pre-malignant scaly skin lesions Rare AR disorder Abnormal susceptibility to HPV 5 and 8
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epidermodysplasia verruciformis
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Patients with a rare autosomal recessive condition, epidermodysplasia verruciformis, which is marked by a high susceptibility to cutaneous squamous cell carcinomas HPVs infect these patients = __ and __ strains
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5, 8
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epidermodysplasia verruciformis, prone to _ _ _ cancers
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SCC
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Tonsil cancer, 50% are due to _ _ _ infection, strain = ___
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HPV, 16
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Papillomaviruses, DNA or RNA?
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DNA
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In CIN3, which genes are expressed by the cervical epithelium?
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E6, E7
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True/false: 95% of CIN1 regresses to normal epithelium
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True
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CIN1 has which viral proteins expressed by the surface epithelium?
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L1, L2
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A tumour promotor, HPV infection PLUS ______ = increases risk of cervical carcinogenesis
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smoking
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True/false: smoking is a protective factor against cervical cancer
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False
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True/false: viral HPV DNA is integrated into the genome
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True
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E6 activates this enzyme inducing immortality
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telomerase
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E6 binds to ____ causing its degradation
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p53
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E7 binds to _____ causing its degradation
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pRb
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pRb usually inhibits ______
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E2F
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pRb = a ___ ___ gene
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tumour suppressor
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The papillomavirus capsid is made of ___ pentamers of __ protein
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72, L1
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Viral protein of HPV that targets p53
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E6
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Viral protein of HPV that targets pRb
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E7
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When did the HPV vaccine program start, in ____
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2007
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Cervical cancer in Australia = common or uncommon?
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uncommon
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Cervical cancer globally = common or uncommon?
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common
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True/false: often a person is asymptomatic until they have a bulky cervical cancer
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True
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Known risk factors of cervical cancer - ___ coitarche (early or late?)
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early
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Known risk factors of cervical cancer - multiple or few sexual partners?
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multiple
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True/false: a known risk factor of cervical cancer is low SES.
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True
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True/false: smoking is a known risk factor of cervical cancer
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True
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Most common clinical presentation of a cervical cancer lesion
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asymptomatic
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A common clinical presentation of cervical cancer: _____ bleeding
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postcoital
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Staging of cervical cancer, ____ staging
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FIGO
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FIGO staging of cervical cancer, is it "surgical" or "clinical"
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clinical
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How many stages of cervical cancer are there in FIGO staging?
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4
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Stage 1 FIGO cervical cancer = _______ to the ______
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confined, cervix
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Stage 2 FIGO cervical cancer = ______ spread
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local
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Is CT and MRI used for staging in cervical cancer?
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no
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Can cystoscopy be used for staging in cervical cancer?
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yes
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Can an intravenous pyleogram be used for staging in cervical cancer?
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yes
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IVP in staging for cervical cancer - what are you looking for?
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hydronephrosis
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Can a PET scan be used for staging in cervical cancer?
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no
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Can a CXR be used for staging in cervical cancer?
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yes
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Bladder and bowel involved, which stage of cervical cancer (FIGO)?
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4
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A cervical cancer involves the pelvic side wall. What stage of cervical cancer (FIGO)?
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3 (B)
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True/false: cervical cancer has a predictable natural history
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True
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Most common pattern of spread in cervical cancer, via the
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lymphatics
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Early stage cervical cancer, is Stage __ __
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1B
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Stage 1B cervical cancer is considered "_____" cervical cancer
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early
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2 treatment options for Stage 1B cervical cancer
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radiation, surgery
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A cervical cancer that is big enough you can see it, but it hasn't spread to adjacent vagina or parametrium, Stage =
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1B
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Surgery or radiation? , therapy options for treating cervical cancer Advantage = preserves sexual function
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surgery
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Surgery or radiation? , therapy options for treating cervical cancer Disadvantage = vagina shortens, atrophies away and dilators are required
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radiation
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Surgery or radiation? , therapy options for treating cervical cancer >> preserves ovarian function
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surgery
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Surgery or radiation? , therapy options for treating cervical cancer Disadvantage = ovaries go
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radiation
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Surgery or radiation? , therapy options for treating cervical cancer >> suitable for all stages of the disease
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radiation
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Surgery or radiation? , therapy options for treating cervical cancer >> gives accurate assessment of the extent of disease
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surgery
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Can radiation be a primary treatment for Stage 1B cervical cancer?
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yes
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Can surgery be a primary treatment for Stage 1B cervical cancer?
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yes
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Primary radiation therapy, 2 modalities a) _____ beam b) b________
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external, brachytherapy
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The source of gamma radiation used in brachytherapy
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iridium 92
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Radiation therapy for treating Stage 1B cervical cancer Give with concurrent ________
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chemotherapy
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Chemotherapy agent given on first day of radiation therapy (treating cervical cancer)
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cisplatin
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radiation therapy administered at a distance from the body =
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teletherapy
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radiation therapy in which the source of radiation is implanted in the tissue to be treated =
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brachytherapy
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Stage 1A cervical cancer is _______
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<3 mm
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How to treat Stage 1A cervical cancer
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cone biopsy
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Primary surgery treatment for Stage 1B and 2A cervical cancer =
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radical hysterectomy
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Role of lymphadenectomy in early stage cervix; - is it "therapeutic"?
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no
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Role of lymphadenectomy in early stage cervix; - to see whether ____ is needed
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radiation
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Complication of lymphadenectomy in treating cervical cancer
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lymphoedema
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surgery to remove the cervix, the upper part of the vagina and lymph nodes in the pelvis
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radical trachelectomy
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The fertility-sparing surgery option in treating cervical cancer
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radical trachelectomy
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This operation cuts out the cervix and attaches the uterus to the vagina
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radical trachelectomy
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radical trachelectomy, associated with ______ births
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preterm
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Adjuvant treatment in cervical therapy, when ____ ____ are positive
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lymph nodes
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The chemotherapy agent used with radiation therapy in cervical cancer is ______-containing chemo
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platinum
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platinum complexes react in the body, binding to DNA and causing the DNA strands to crosslink >> apoptosis Chemo drug =
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cisplatin
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Why is chemotherapy used concurrently with radiation therapy for cervical cancer? As a
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radiation sensitiser
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Late-stage cervical cancer, stages ___ to ___
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2B, 4
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For recurrent disease in cervical cancer, the treatment is
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radiation
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lined by columnar epithelium that secretes mucus Ectocervix or endocervix
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endocervix
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covered by nonkeratinizing, stratified squamous epithelium, either native or metaplastic Ectocervix or endocervix
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ectocervix
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the boundary between the ectocervix and endocervix meet
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squamocolumnar junction
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area between original SC junction and new SC junction due to regenerative metaplastic response
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transformation zone
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a luminal cavity within the cervix forming a passageway between the external os and the internal os
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endocervix
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The ectocervix is covered by ____-_______, _____ _______ epithelium, either native or metaplastic in continuity with the vaginal epithelium
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non-keratinizing, stratified squamous
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one layer of mucin secreting cells line the _______ (part of the cervix)
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endocervix
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The SCJ is the result of a continuous ________ process resulting from uterine growth, cervical enlargement and hormonal status
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remodeling
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At birth and during pre-menarchal years, the SCJ is located at or very close to the ____ _____ (original SCJ)
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external os
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Progressively through a process called _______ the transformation zone is replaced by squamous epithelium
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metaplasia
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Area between the original SCJ and the new SCJ where the columnar epithelium has been replaced by the new metaplastic squamous epithelium
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transformation zone
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Is the Papsmear a reliable test?
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no
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Which is easier to read for diagnosis - Papsmear or liquid-based cytology?
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liquid-based cytology
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Abnormal cytologic changes of squamous epithelial cells = (esp in cervical cancer) = called:
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dyskaryosis
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Can CIN be diagnosed on a Papsmear?
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no
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dyskaryosis is synonymous with
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dysplasia
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Suspicious Papsmear.... what technique we do next?
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colposcopy
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Benign finding in the transformation zone = blocked cervical gands >> glandular tissue metaplasia and gland cells underneath become cysts
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Nabothian cysts
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a mucus-filled cyst on the surface of the cervix = _____ cyst
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Nabothian
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Is Nabothian cyst pathological?
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no
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What colposcopy can tell us: s____, l_____, t_____ Is it accurate?
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size, location, topography, no
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What should you always get when you're doing colposcopy?
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biopsy
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3 treatment options for cervical dysplasia (L___, L____, c_____)
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laser, LEEP, cone
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An approach to treat high grade cervical dysplasia discovered on colposcopic examination: a wire loop through which an electric current is passed
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LEEP
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An approach to treat cervical dysplasia discovered on colposcopic examination: BURN it = using a
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laser
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An approach to treat high grade cervical dysplasia - an excision =
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cone
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laser, LEEP, cone = 3 treatment options for ______ _____ that is discovered on colposcopy
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cervical dysplasia
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Two types of growth patterns of a cervical cancer =
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exophytic (cauliflower), endocervical
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Is CT, PET and MRI used for staging in cervical cancer?
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no
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Stage 1A, <___ mm tumour size and ____ to the cervix
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3, confined
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If clinically-visible AND confined to the cervix = Stage ____
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1B
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if tumour has spread to the vagina, but not the pelvic side wall, Stage ___
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2A
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Stage 4 cervical cancer = which organs may be involved? (2)
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bladder, rectum
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In the transformation zone, which epithelium "migrates"?
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columnar
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Transformation zone: When the columnar epithelium migrates outwards and is converted back into squamous epithelium =
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metaplasia
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HPV integrates into the cells and causes cervical _____
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dysplasia
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CIN grading of dysplasia depends on the _____ of the epithelium involved
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thickness
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Main cancers of the cervix (2)
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squamous cell carcinoma, adenocarcinoma
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When is chemoradiotherapy going to be the primary treatment for cervical cancer? When the cancer is
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too big (to remove surgically)
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Why do we do an EUC in the work-up for cervical cancer? >> the cancer may have spread to the pelvic ___ ____ and could be obstructing the _____
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side wall, ureter
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Acute renal failure in a patient with Stage 4 cervical cancer, due to tumour obstructing the
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ureter
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True/false: renal function needs to be good for radiotherapy
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.True
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Aim of Stage 1B radiation therapy: ______ (cervical cancer)
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cure
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Dose needed to cure cervical cancer = ____ Gray
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80
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Radiation dose is limited by the surrounding tissue; in cervical cancer, what is at risk if you give radiation over 40 Gray?
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small bowel
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Intrauterine _____ delivers half the dose of radiation therapy in treatment of cervical cancer
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brachytherapy
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Acute effects of EBRT, due to ______ of surrounding tissues
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inflammation
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Common organs affected acutely in radiation therapy of cervical cancer (2)
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bladder, bowel
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Long-term side effect of radiation therapy in cervical cancer = i_____
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infertility
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Late side effects of radiation therapy (EBRT) is due to s_____
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scarring