4 Cervical cancer – Flashcards
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Most common cancers in women worldwide: Number 2) =
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colorectal
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Most common cancers in women worldwide: Number 3) =
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lung
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Most common cancer in women worldwide: Number 4) =
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cervical
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A pre-neoplastic condition of the cervix = cervical _____
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dysplasia
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Whether cervical dysplasia progresses to carcinogenesis, depends on: - persistent ____ infection - host ____ status
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HPV, immune
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Chance of surviving at least 5 years after cervical cancer diagnosis in Australia =
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70%
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The number of new cases of cervical cancer diagnosed each year, in the last 20 years, has: (increased or decreased)
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decreased
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Cervical cancer prevalence - developed or developing world?
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developing
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renewed National Cervical Screening Program will invite women aged ____ to ___ years, both HPV vaccinated and unvaccinated, to undertake an HPV test every 5 years
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25, 74
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renewed National Cervical Screening Program will invite women aged 25 to 74 years to undertake an ____ test every 5 years
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HPV
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renewed National Cervical Screening Program will invite women aged 25 to 74 years to undertake an HPV test every ___ years
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5
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Will both vaccinated and unvaccinated women have HPV tests in the new program?
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yes
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Does a Papsmear test for the HPV virus?
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no (looks at abnormal cells)
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Current Papsmear program: for ages ___ to 69
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18
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True/false: Papsmears have a lot of false positives and negatives.
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True
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Benefit of cervical cancer screening:
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decreased incidence
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True/false: HPV has a viral envelope
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False
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True/false: HPV is a DNA virus
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True
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HPV virus = DNA or RNA?
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DNA
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70% of cervical cancer is due to these strains of HPV
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16, 18
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True/false: HPV is needed for cervical cancer
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True
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Cervical cancer screening: The current program recommends ____-yearly Pap tests for women aged 18-70 who are or have ever been sexually active.
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2
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Cervical cancer screening: Under the new program, women aged 25-74 will be tested for ____ every ____ years.
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HPV, 5
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Who are the people that get cervical cancer nowadays? Those who lapsed the
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screening
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Changing cervical cancer screening, to a ____ test every ___ years
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HPV, 5
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If a patient tests HPV+ after a sample has been taken and tested, next step =
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cytology
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At what age is cervical screening going to start with the new program? At age
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25
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Worldwide, new diagnoses of cervical cancer per year =
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500,000
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Aetiology of cervical caner 1) ______ infection with oncogenic ___
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persistent HPV
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HPV causes which cancer?
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cervical
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True/false: 99.7% of cervical cancers test positive for HPV
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True
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Is persistent HPV always going to cause cancer?
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no (cofactors)
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#1 co-factor associated with cervical cancer i.e. need persistent HPV infection PLUS co-factor =
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smoking
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Co-factors that contribute to cervical cancer risk - s_____ - long-term ____ use - ____ co-infection - high p_____
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smoking, OCP, HIV, parity
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True/false: HPV cancer is associated with oropharyngeal cancer.
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True
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Genital warts, caused by HPV strains (2)
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6, 11
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Most HPV infections are transient and are eliminated by the immune response in the course of _____ (days, months, years)
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months
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HPVs infect immature ______ cells of the squamous epithelium in areas of epithelial breaks
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basal
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Most HPVs infect the ___
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skin
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CIN, is also known as
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cervical dysplasia
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True/false: Most types of HPV do not cause any symptoms and go away on their own.
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True
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About ___ (number) HPV infections affect the genital area
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40
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__% Australians will be affected with HPV of some type at some point in their lives
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80%
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True/false: HPV infection could almost be considered a normal part of being sexually active.
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True
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Main route of transmission of HPV
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sexual intercourse
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a test that can detect abnormal cells in the cervix that may lead to cervical cancer
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Papsmear
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CIN grades cervical ____
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dysplasia
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Cervical dysplasia grading system = _ _ _
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CIN
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CIN grading, 1 to ___
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3
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HPV is a ___ virus, approx. _____ base pairs
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DNA, 8000
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HPV, over ____ different genotypes
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200
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Oncogenes of HPV, = (2)
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E6, E7
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an examination of the cervix with a special microscope
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colposcopy
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HPV >> precancerous lesions increase the risk of cancer of the c_____, v_____; also in males: p_____, + o_______
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cervical, vagina, penis, oropharynx
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The late region of the HPV genome, encodes for the ____ proteins
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capsid
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The early region of the HPV genome, encodes for ________ proteins
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non-structural
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The E in E6 and E7 stands for ____ genes
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early
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True/false: HPV can integrate into the host cell genome
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True
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E6 binds and degrades this TSG
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p53
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The ectocervix, epithelium =
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stratified squamous
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The endocervix, epithelium =
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columnar
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The columnar epithelium endocervix secrets
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mucus
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HPV enters through a micro-abrasion and infects - which cells ?
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basal cells
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True/false: most HPV infection is naturally cleared within 1-2 years
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True
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If there is persistent HPV infection, ______ integrate with the host's DNA
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episomes
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extra-chromosomal genetic material that may become integrated into the chromosome or replicate autonomously
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episome
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When does cervical dysplasia become cervical cancer? When it has _____ the ____ _____
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invaded, basement membrane
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2 types of HPV vaccination
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Gardasil, Cervarix
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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
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