CPC - neoplasia - lecture notes - julia Flashcards Preview

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Flashcards in CPC - neoplasia - lecture notes - julia Deck (13)
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1
Q

what does a diagnosis of ASCUS mean?

A
  • in response to a pap smear
  • someplace in between normal and abnormal cells
  • atypical squamous cells of unknown significance
  • 20-30% of people get this diagnosis
  • would do a biopsy to figure otu what to do from there
2
Q

what is the prevalence of HPV in the US? what is the incidence rate of new infections?

A
  • 20 million currently infected
  • 5.5 million infected each year
3
Q

how long do HPV-associated cancers take to develop? how do rates of cervical cancer amoung young women compare to other cancers?

A
  • can take 10 to 20 years to develop
  • cervical cancer affects younger women more frequently than most other types of cancer
4
Q

how many people die of cervical cancer annally worldwide? how many new cases are diagnosed? what age group is most likely to be affected?

A
  • second most common cause of female cancer mortality worldwide
  • approximately 510,000 new cases annually
  • 288,000 deaths
  • most cases between ages 30 and 50
  • 15% of cases in women between 20 and 34
5
Q

describe the progression of cervical cancer

A
  • starts as a benign noninvasive or squamous intraepithelial lesion (SIL) or CIN
  • most low-grade epithelial lesions regress
  • some remain unchagnged
  • 10-15% progress to moderate or severe dysplasia - carcinoma in situ
  • high grade CIN may develop into invasive cancer after years or decades
6
Q

which strains of HPV are most likely to cause invasive or malignant cervical cancers?

A

16, 18, and 45 are the most prevalent detected

on different slide says: 16,18, 31, 39, 45, 59

7
Q

what are the cervical cancer screening guidelines according to the american cancer society? (when to start, in what interval, when to stop?)

A
  • start 3 years after onset of vaginal intercourse but no later than age 21
  • test annually for women under 30
  • every 2-3 years for women over 30 with 3 negative cytology tests
  • liquid based cytology every 2-3 years for women over 30 with 3 negative cytology tests
  • hpv testing every 3 years if HPV and cytology negative
  • stop for women over 70 who have over 3 recent, negative cytology tests and no abnormal tests in 10 years
8
Q

how is a conventional pap smear collected? what does it look like? what are the disadvantages?

A
  • specimen collected with brush - make smear on slide - put on fixative and send to lab
  • problems:
  • majority of cells not captured
  • non-representative transfer of cells
  • clumping and overlapping of cells
  • obscuring material
9
Q

how is a thinprep pap test performed? what does it look like? what are the advantages of this test over a conventional pap smear?

A
  • specimen also collected with brush - brush put in vial of methanol fixative - cells fixed instantaneously - sent off to lab - liquid evaporated and sample put on slide
  • advantages:
  • virtually all of sample collected
  • randomized, represenational transfer of cells
  • even distribution of cells
  • minimizes obscuring material
10
Q

what are the different possible results of a pap smear? what do they mean? what do you do in response? (4)

A
  1. normal
  2. ascus - atypical cells of unclear significance
    - repeat pap and test for HPV DNA
  3. LSIL = low grade squamous intra-epithelial lesion
    - colposcopy with biopsy
  4. HSIL = high grade squamous intra-epithelial lesion
    - colposcopy with biopsy and treat
11
Q

what are the possible results of a cervical biopsy? (5) what do you do for each?

A
  1. CIN I = mild dysplasia
    - usually spontaneously regresses
  2. CIN II = moderate dysplasia
    - treat
  3. CIN III = severe dysplasia
    - treat
  4. carcinoma = in situ
    - treat
  5. invasive cervical cancer
    - treat
12
Q

how does HPV cause cancer? (what do the viral proteins do that is carcinogenic?)

A
  • protein E6 interacts with the host cell p53 and promotes its degradation via ubiquitin dependent pathway
  • protein E7 complexes with Rb protein => inactivation of Rb
13
Q

what are the possible treatments for “high risk” hpv? (6)

A
  • colposcopic biopsy - diagnosis for the state/grade of the HPV infection (high or low grade)
  • LEEP = loop electrocautery excision procedure - cuts out infected site = most common procedure
  • laser - burns off infected site
  • cryosurgery - freezes off infected site
  • general surgery = hysterectomy, vulvectomy (in rare cases)
  • natural products - eg stress reduction, immune system boosters