CM Cervical Disorders – Flashcards

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normal cervix
normal cervix
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differences in nulliparous and parous (os never completely goes back to smaller diameter)
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acute cervicititis
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brillant redness of cervix redness friable (speculum touches and causes bleeding) tend to be infectious causes
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chronic cervicitis
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clear mucusou/watery discharge granular redness scarring cervical stenosis tend to be non-infectious causes
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cervicitis due to infection
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purulent discharge etiology: gonorrhea chlymydia HPV trichomonas micoplasma genitalian (BV) cytomegalovirus BV
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noninfectious cervicitis
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Mechanical irritation Chemical irritation/allergic response Trauma (intercourse, surgery) Systemic inflammatory disease Radiation
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cervicitis Sx
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spotting discharge pain irritation dysuria is os open or not? complications scarring abnormal bleeding cancer could spread tx underlying cause
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nabothian cysts - glands that have not completely opened up;' normal physical finding
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Dx: colposcope (magnify lens looking at cervix)
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endocervical polyps usually benign
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bleed w/ interDx: ect Dx bx to r/o cancer Tx ring forcep, twist off silver nitrate cauterate for hemostasis removal about 90% curative
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cervical cancer
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asypmtomatic vaccine to 100% prevent it Third most common gyn cancer Leading cause of cancer death in medically underserved countries 75% decrease in incidence due to screening
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leading cause of cancer death in medically underserved countries
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cerivial cancer less in US because of pap smears/screening
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site most common for cervical cancer
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normal metaplastic transformation zone (from columnar to squamous cells)
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Pap terminology results KNOW MEANING
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normal atypical squamous cell of ... ASC-US ASC-H = atypical squamous cell LSIL (low grade) HSIL (high grade; moderate, severe) Cancer
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histology pap terminology (bx results) insert pic slide 21
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CIN 1 Low grade dysplasia 10% progress to CIN 2,3 CIN 2 High grade dysplasia 5% progress to cancer if untreated CIN 3 High grade dysplasia 12-40% progress to cancer if untreated CIS Invasive carcinoma
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HPV and cervical cancer 80% of women infected with HPV by age 50 Incidence of cervical cancer rises after age 40 Average age of diagnosis of cancer 48 yrs in US
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risk factor have intercourse at young age because kertinazaion of transitional zone underdeveloped
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HPV risk factors
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Multiple sexual partners High risk sexual partner Young age (3 live births) Early age at first birth (<20 yr) Younger age at first full-term pregnancy Genetic?
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cervical cancer development
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Oncogenic HPV infection at transformation zone (Squamo-Columnar Junction) Persistence of HPV infection
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natural history of HPV
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skin disease slide 23 normal cervix HPV infection (asymptomatic) persistent/clearance progression/regression pre-cancer (want to rid cells, can't rid virus) cancer Time from initial infection to cancer about 15 years. Transient infections are usually cleared within 6-18 months Greater chance of regressing in younger women
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role of HPV
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More than 100 subtypes of HPV Subtype 6,11 cause warts Most frequent oncogenic types: 16, 18, 31, 33, 45, 52, 58 Subtypes 16 and 18 are found in >70% of cervical cancers HPV present in 99.7% of all invasive cancers
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HPV subtypes that cause genital warts
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6 11
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HPV subtypes that cause cervical cancers
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16 (squamous cell carcinoma) 18 (adenocarinoma from columnar glandular cells; most common < 35)
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types of cervical cancer
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Squamous cell carcinoma 70-75% Adenocarcinoma 20-25% Adenosquamous carcinoma 3-5% Undifferentiated carcinoma Neuroendocrine carcinoma
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screening guidelines
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start screening age 21 Do not colpo until age 25 (unless HSIL Pap) Do not do HPV testing under age 30 30 yo (after 3 consecutive negative) Pap q 3 years OR Pap + HPV every 5 years Stop screening >65 yo if 3 negative, but if new partner... Immunocompromised or history of cervical dysplasia continue annual screening
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cervical cancer Sx
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asymptomatic (early) abnormal vaginal bleeding vaginal discharge pain systemic symptoms -anemia -weight loss cervical lesion on speculum exam or palpated on bimanual exam
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cervical cancer Dx
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pap test colposcopically guided bx bx anything suspicious endocervical curettage conization of the cervix clinical exam and imaging for staging LEEP= electrocautery conization
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cervical cancer staging just FYI, no test
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I: carcinoma confined to the cervix II: invades beyond the uterus, but not to the pelvic wall or lower third of vagina III: tumor extends to the pelvic wall and/or involves lower third of the vagina and/or causes hydronephrosis IV: carcinoma has extended beyond the true pelvis or involves the mucosa of the bladder or rectum
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cervical cancer Tx
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surgery chemotherapy radiation Preinvasive/Microinvasive LEEP, CKC, simple hysterectomy Early stage (IA2-IIA) Radical hysterectomy and pelvic lymphadenectomy Primary radiation with concurrent chemotherapy Locally advanced (IIB-IVA) Primary radiation with concurrent chemotherapy Metastatic, persistent or recurrent Chemotherapy Palliative radiation Central pelvic recurrence Total pelvic exenteration
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cervical cancer factors affecting prognosis
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Stage Histologic cell type and grade Depth of invasion Lymph node involvement Recurrence
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cervical cancer prognosis
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Untreated/fails to respond to treatment 2 yr 5% Stage IB 5yr 80% IIA,B 5yr 58-63% III 5yr 30% IVA 5yr 16%
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cervical cancer prevention
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HPV vaccine Approved for females (and males) 9-26 yo (insurance won't cover older ones currently) Ideally vaccinate before exposure to HPV (11-12 yrs old...before sexually active) GARDASIL®: Quadrivalent vaccine HPV subtypes: 16, 18 ,6 , 11 (6 and 11 are condyloma) **GARDASIL®9 HPV subtypes: 6, 11, 16, 18, 31, 33, 45, 52, and 58 CERVARIX Bivalent vaccine against HPV subtypes 16,18 Highly immunogenic Some protection against severe disease even in those with prior HPV infection (b/c may not have had all the strains) ~100% time if not exposed ~50% time if exposed not a live vaccine 3 shots over 6 mo period effective in cervical, vulvar, vaginal, rectal HPV cancers
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