CNBY Final Exam

Cervix Anatomy and Function

cervix only in women, part of female reproductive tract, in between vagina and uterus

Parts of the cervix

Ectocervix (outer)

Endocervix (inner)

Squamocolumnar junction (transformation zone)

Ectocervix

Outer part of cervix that can be seen during gynecology exam and is lined with stratified squamous epithelium, providing protection against pathogens.

Endocervic

Inner part of cervix that forms canal that connects the vagina to uterus. Covered with columnar glandular cells that secrete mucus.

Squamocolumnar junction

Also known as the transformation zone, border where endocervix and ectocervix meet. Most cervical cancers begin in this area

How many new cases of invasive cervical cancer are diagnosed each year?

About 13,360 new cases

How many women die from cervical cancer each year?

About 4,320 women

Are cervical pre-cancers or invasive cervical cancers diagnosed more often?

Cervical pre-cancers are diagnosed far more often than invasive cervical cancer.

At what age is cervical cancer most frequently diagnosed in women?

Between ages 35 and 44.

What is the average age of cervical cancer diagnosis?

About 50 years old.

Is cervical cancer common in women under 20?

No, it rarely develops in women younger than 20.

Squamous cell carcinoma

Develop from cells in the ectocervix (in particular- the transformation zone/squamocolumnar junction)

What percent of cervical cancers are squamous cell carcinomas?

90% of cervical cancers are squamous cell carcinomas.

Adenocarcinoma

Develops in the glandular cells of the endocervix

What is the primary risk factor for cervical cancer?

HPV

What increases the risk that an HPV infection will lead to cervical cancer?

Immunosuppression, smoking and obesity

How does immunosuppression increase cervical cancer risk?

It weakens the body’s ability to fight HPV, especially in people with HIV or those taking immune-suppressing drugs

Why is smoking a risk factor for cervical cancer?

Smoking damages the cells of the cervix and weakens the immune system, increasing cancer risk

How does obesity relate to cervical cancer risk?

Obesity is associated with a higher risk of cervical cancer due to hormonal and metabolic chnages

What is DES and how is it linked to cervical cancer?

Diethylstilbestrol (DES) is a synthetic estrogen once given to pregnant women (1940–1971) to prevent miscarriage, which increased the risk of cervical and other reproductive cancers in exposed daughters

When was DES commonly prescribed to pregnant women?

Between 1940 and 1971

What is HPV?

Human Papillomavirus is a group of over 200 related viruses, some of which are sexually transmitted

How is HPV spread?

Vaginal, anal or oral sex

What are the 2 groups of sexually transmitted HPV types?

Low-risk (can cause genital warts) and high-risk (can cause cancer)

How common is HPV infection among sexually active people?

Nearly all sexually active people will become infected with HPV at some point in their lives

Can high-risk HPV types cause cancer?

Yes, high-risk HPV types can lead to various cancers, including cervical cancer.

Which 2 HPV types are responsible for most HPV-related cancers?

HPV 16 and HPV 18 which account for 70-80% of cases

What types of cancer can HPV cause?

Cervical, anal, oropharyngeal, penile, vaginal, and vulvar cancer

What causes virtually all cervical cancers?

Long-lasting infection with high-risk types of HPV

Do all HPV infections cause cancer?

No, most go away on their own within a year or two and do not cause cancer

How can a high-risk HPV infection lead to cervical cancer?

If it lasts for years, it can cause precancerous changes in cervical cells, which may develop into cancer if not treated

What factors increase the risk of getting infected with high-risk HPV types?

Becoming sexually active at a young age (especially before 18) and having multiple sexual partners

Why is cervical cancer hard to detect early?

It usually does not have symptoms in the early stages

When do cervical cancer symptoms typically begin?

After the cancer has spread

What are early-stage symptoms of cervical cancer?

Vaginal bleeding after menopause, Bleeding between periods or unusually heavy/long periods, Watery, strong-smelling or bloody vaginal discharge, Pelvic pain or pain during sex, Vaginal bleeding after sex are often subtle or mistaken for other conditions.

What are symptoms of advanced cervical cancer?

Painful or difficult bowel movements, or bleeding from the rectum, Painful or difficult urination, or blood in the urine, Dull backache, Swelling of the legs, Abdominal pain, Fatigue

What is a Pap test?

A test that collects cervical cells to be examined under a microscope for abnormal changes

Who is the Pap test named after?

Dr. Papanicolaou

What is an HPV test used for?

To check for infection with the HPV using a swab of the cervixThe HPV test is used to determine if a woman has a high-risk type of HPV that can lead to cervical cancer.

Are the Pap test and HPV test often done together?

Yes, both tests are often performed to increase the accuracy of screening

What does a result of “A” in a Pap test indicate?

Healthy exfoliated superficial squamous epithelial cells

What does a result of “B” in a Pap test indicate?

Low-grade squamous intraepithelial lesion (LSIL), which suggests mild cell changes often linked to HPV infection

What do results “C” and “D” in a Pap test indicate?

High-grade squamous intraepithelial lesions (HSILs), which suggest more serious cell changes and a higher risk of progressing to cervical cancer

How are squamous intraepithelial lesions (SIL) usually detected?

Through an abnormal Pap test, as SIL is typically asymptomatic and often requires further evaluation such as a colposcopy for confirmation.

What is colposcopy and how is it used in diagnosis?

A procedure that uses acetic acid to highlight abnormal areas on the cervix for biopsy following an abnormal Pap test

How are (LSIL) typically managed?

With conservative treatment and careful observation

How are HSIL or persistent LSIL treated?

With surgical excision, such as cone biopsy

What is colposcopy?

A procedure used to closely examine the cervix for abnormalities using a microscope-like instrument called a colposcope.

What instrument is used in a colposcopy, and where is it placed?

A colposcope, placed close to the vagina to visualize the cervix

Does a colposcopy usually include a biopsy?

Yes, to collect samples of abnormal tissue for further analysis

What does SIL stand for and what does it indicate?

Squamous Intraepithelial lesion, a precancerous change in the cervix

What does CIN stand for?

Cervical Intraepithelial Neoplasia, another term for precancerous cervical cell changes

What is the most common type of cervical cancer?

Squamous cell carcinoma, accounting for up to 90% of cases

Where does squamous cell carcinoma develop?

In the squamous cells of the ectocervix (outer part of cervix)

What is cervical adenocarcinoma and where does it develop?

A type of cervical cancer that develops in the glandular cells of the endocervix (inner part of cervix)

What are the precancerous stages?

Squamous intraepithelial lesions (SILs), low and high grade SIL (LSIL and HSIL), and CIN 1-3

What does SIL stand for and what does it reflect?

Squamous Intraepithelial Lesion; it reflects the biology of the disease

What is LSIL and how does it behave?

Low-grade SIL; more common, often regresses and is not considered truly premalignant

What is HSIL and how does it behave?

High-grade SIL; less common, but has a higher chance of progressing to cancer

What is the 3-tier system used for staging precancerous lesions?

Cervical Intraepithelial Neoplasia (CIN): CIN1,2 or 3

What is the most common type of malignant cervical cancer?

Squamous cell carcinoma

Who is most often diagnosed with cervical cancer?

Patients who have never had a Pap test or haven’t been screened for years

What are common symptoms of cervical cancer?

Vaginal bleeding, leukorrhea (vaginal discharge), dyspareunia (painful sex) and dysuria (painful urination)

What is the primary treatment for cervical cancer?

Hysterectomy and lymph node dissection

When are radiation and chemotherapy used for cervical cancer?

When surgery alone is not curative

What is the 5 year survival rate for localized cervical cancer?

91%

What is the 5 year survival rate for regional cervical cancer?

61%

What is the 5 year survival rate for distant cervical cancer?

19%

What is ther overall 5 year survival rate across all-SEER stages?

67%

How can HPV vaccines help prevent cervical cancer?

By preventing infection with high-risk HPV types that cause most cervical cancers

What is the name of the FDA-approved HPV vaccine?

Gardasil 9

What age group is Gardasil 9 approved for?

Males and females aged 9 to 45

Which HPV types does Gardasil 9 protect against?

Cancer-causing: 16, 18, 31, 33, 45, 52, 58; Genital warts: 6 and 11

Does the HPV vaccine treat existing HPV infections?

No, it only prevents new infections

Should vaccinated individuals with a cervix still get screened?

Yes, they should follow regular screening guidelines

What are the cervical cancer screening recommendations for 21 and younger?

Not recommended

What are the cervical cancer screening recommendations for 21- 29?

pap smear every 3 years

What are the cervical cancer screening recommendations for 30 -65?

Pap smear every 3 years, HPV test every 5 years, or co-testing every 5 yearsPap smear every 3 years, HPV test every 5 years, or co-testing every 5 years.

What are the cervical cancer screening recommendations for 65 and older?

Not recommended if adequately screened and low riskand if previous screenings have been normal.

Who needs more frequent cervical cancer screening?

HIV positive individuals, Those with weakened immune systems, DES exposure, Recent abnormal screening/biopsy, History of cervical cancer

Why is early detection of SIL important?

Because cervical cancer is typically slow-grading and early detection allows treatment before progression

How common is cervical cancer globally among women?

It’s the 4th most common cancer in women

What were the global cervical cancer statistics in 2022?5

~660,000 new cases and ~350,000 deaths

Where are the highest cervical cancer incidence and mortality rates?

In low and middle income countries

What causes these high rates in certain countries?

Lack of access to HPV vaccines, cervical screening, treatment services and socioeconomic inequities

What does pancreas mean?

“All” + “Flesh”

What are the 2 main functional components of the pancreas?

Exocrine (acinar cells) and endocrine (islets of Langerhans)

What is the function of the exocrine pancreas?

Produces digestive enzymes

What is the function of the endocrine pancreas?

Regulates blood glucose via insulin production (beta cells)

What is the most common form of pancreatic cancer?

Pancreatic ductal adenocarcinoma (PDAC)

What percentage of pancreatic cancers are PDAC?

About 80%

Where does PDAC begin?

In the ductal cells of the pancreas

What do the ductal cells in the pancreas do?

Transport enzyme-containing digestive juices into the small intestine

How many new pancreatic cancer cases are expected in the US in 2024?

66,440 cases

How many deaths from pancreatic cancer are expected in 2024?

51,750 deaths

How has the incidence of pancreatic cancer changed over time?

It has markedly increased over the past several decades

What is the lifetime risk of developing PDAC for men and women?

1 in 56 men; 1 in 60 women

How does family history affect pancreatic cancer risk?

Inherited mutations increase the risk

What percentage of pancreatic cancers is linked to smoking?

~ 25%

How does obesity affect the risk of pancreatic cancer?

Increases the risk by 20%