CM Cervical Disorders – Flashcards

differences in nulliparous and parous (os never completely goes back to smaller diameter)

brillant redness of cervix redness friable (speculum touches and causes bleeding) tend to be infectious causes

clear mucusou/watery discharge granular redness scarring cervical stenosis tend to be non-infectious causes

purulent discharge etiology: gonorrhea chlymydia HPV trichomonas micoplasma genitalian (BV) cytomegalovirus BV

Mechanical irritation Chemical irritation/allergic response Trauma (intercourse, surgery) Systemic inflammatory disease Radiation

spotting discharge pain irritation dysuria is os open or not? complications scarring abnormal bleeding cancer could spread tx underlying cause

Dx: colposcope (magnify lens looking at cervix)

bleed w/ interDx: ect Dx bx to r/o cancer Tx ring forcep, twist off silver nitrate cauterate for hemostasis removal about 90% curative

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

cerivial cancer less in US because of pap smears/screening

normal metaplastic transformation zone (from columnar to squamous cells)

normal atypical squamous cell of ... ASC-US ASC-H = atypical squamous cell LSIL (low grade) HSIL (high grade; moderate, severe) Cancer

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

risk factor have intercourse at young age because kertinazaion of transitional zone underdeveloped

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?

Oncogenic HPV infection at transformation zone (Squamo-Columnar Junction) Persistence of HPV infection

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

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

6 11

16 (squamous cell carcinoma) 18 (adenocarinoma from columnar glandular cells; most common < 35)

Squamous cell carcinoma 70-75% Adenocarcinoma 20-25% Adenosquamous carcinoma 3-5% Undifferentiated carcinoma Neuroendocrine carcinoma

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

asymptomatic (early) abnormal vaginal bleeding vaginal discharge pain systemic symptoms -anemia -weight loss cervical lesion on speculum exam or palpated on bimanual exam

pap test colposcopically guided bx bx anything suspicious endocervical curettage conization of the cervix clinical exam and imaging for staging LEEP= electrocautery conization

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

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

Stage Histologic cell type and grade Depth of invasion Lymph node involvement Recurrence

Untreated/fails to respond to treatment 2 yr 5% Stage IB 5yr 80% IIA,B 5yr 58-63% III 5yr 30% IVA 5yr 16%

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