Cervical Disease and Neoplasia Reading

HPV 16 and 18

most common cause of cervical cancer

E6 → inhibits p53

E7 → inhibits Rb

what are the oncoproteins produced in the pathogenesis of cervical cancer?

1️⃣ HPV infects basal epithelial cells2️⃣ Viral DNA integrates into host genome3️⃣ Oncoproteins produced:

mechanism of the pathogenesis of cervical cancer

p53

E6 oncoprotein inhibits

Rb

E7 oncoprotein inhibits

CIN 1 → CIN 2 → CIN 3 → invasive carcinoma

progression of cervical cancer:

squamous cell carcinoma

most common type of cervical cancer (cell type)

HPV (human papilloma virus)

most common STI worldwide

Most sexually active people infected at some point

Most infections clear spontaneously

HPV 6, 11

HPV types causing genital warts

Ages 9–12

Recommended up to age 26

recommended ages for HPV vaccination

2 doses

number of HPV doses for pts under 15

3 doses

number of HPV doses for patients 15 and up

HPV 16 & 18 (high-risk)

HPV 6 & 11 (warts)

Additional oncogenic strains (9-valent vaccine)

what HPV strains does the vaccine cover?

Persistent high-risk HPV

Early sexual activity

Multiple partners

Smoking

Immunosuppression (HIV)

Long-term OCP use

High parity

Lack of screening

risk factors for cervical neoplasia

pap smear every 3 years

cervical cancer screening guidelines age 21-29

Pap every 3 years

HPV testing every 5 years

Co-testing every 5 years

cervical cancer screening recommendations for ages 30-65 years

>65

at what age can you stop screening for cervical cancer?

HIV → start at diagnosis

16 year old tests positive for HIV, do you screen for cervical cancer?

HPV negative → routine screening

HPV positive → colposcopy

if ASC-US shows up in cervical screening---->

<25 → observe

≥25 → colposcopy

management of low grade squamous intraepithelial lesion

Colposcopy or immediate excisional procedure (LEEP)

management of high grade squamous intraepithelial lesion

Colposcopy + endocervical sampling

management of atypical glandular cells on screening

CIN 1 → observeCIN 2/3 → excision (LEEP or cone)

management of CIN 1 vs CIN 2/3

Postcoital bleeding

Intermenstrual bleeding

Postmenopausal bleeding

Pelvic pain

Dyspareunia

Vaginal discharge (foul)

late symptoms of cervical cancer

Friable cervical mass

Ulcerative lesion

Irregular exophytic growth

Bleeds easily

physcial exam findings associated with cervical cancer

cervical cancer

postcoital bleeding = _______ until proven otherwise