Background

Question 1

What is the annual incidence of cervical cancer in the U.S.? Mean age?

Answer 1

12K a year

40’s

Question 2

7 lifestyle factors

Answer 2

1. Early onset of sexual activity
2. Larger number of sexual partners
3. Exposure to high-risk partners
4. Hx of STD 5
5. Smoking
6. High parity
7. OCPs

Question 3

What reduction in mortality with PAP screening?

Answer 3

• ~70% reduction in mortality
• Atypical squamous cells of unknown significance

Question 4

What does ASCUS stand for?

Answer 4

• Atypical Squamous Cell of Unknown significance
• 2/3 resolve spontaneously
• Repeat Pap in 6 months and colposcopy if abnormal

Question 5

LGSIL?

Answer 5

• Low grade squamous intraepithelial neoplasia resolves sponteneously 40% of the time
• Repeat PAP in 6 months and colpo if abnormal

Question 6

How should a HGSIL result from a PAP be managed? what percentage become invasive cancers

Answer 6

• All pts with HGSIL should undergo colposcopy with Bx. One-third of these pts can still resolve spontaneously, but waiting without further investigation is not recommended due to concern for progression.
• 22% progress to invasive cancer in contrast to ASCUS <1% and LGSIL ~ 5%

Question 7

HPV is in X % of cervical cancer?

Which subtypes account for the majority of CA?

Which subtypes account for warts?

Answer 7

• >99%
• >70% by 16/18
• 6/11

Question 8

What % are SCCa vs. Adenocarcinoma?

Answer 8

• 80% vs. 20%

Question 9

5 histo types of adenocarcinoma

Answer 9

1. Mucinous
2. Adenosquamous
3. Endometrioid
4. Clear cell
5. Glassy cell

Question 10

Presenting Sx?

Specific area where most cervical cancer originates?

Answer 10

1. abnormal vaginal bleeding
2. postcoital bleeding
3. abnormal vaginal discharge

Transformation zone beween original and present squamocolumnar junction