38 Questions
What is the primary mechanism for cancer prevention in cervical cancer?
Papanicolaou (Pap) testing
What percentage of women are older than 40 years at diagnosis of cervical cancer?
40%
What is the most common type of cervical cancer?
Squamous cell carcinoma
In which region of the United States are rates of cervical cancer higher?
Southern region
How many cases of cervical cancer are diagnosed every year in the United States?
13,000 cases
What percentage of cervical cancers are associated with HPV types 16 and 18?
70%
What is the precursor for the development of cervical cancer?
Human papillomavirus (HPV) infection
What percentage of women with HPV infection will clear the virus within six months?
50%
What is the rate of mortality from cervical cancer among black women compared to white women?
Twice as likely
What percentage of cervical cancers are squamous cell carcinomas?
71%
What percentage of adults 20 to 24 years of age are currently infected with HPV?
50%
What is the primary route of cervical cancer spread?
Direct extension and lymphatic and hematogenous routes
What is the outcome of low-grade dysplasia (CIN1) in most cases?
Regression
What is the purpose of conization in suspected microinvasive disease?
To determine depth of invasion
What is the cervical transformation zone where HPV infection can lead to dysplastic cellular changes?
Metaplastic epithelium
How long after smoking cessation does the risk of squamous cell carcinoma decrease by one-half?
10 years
A woman has a cervical lesion that is microscopically identified as invasive cancer with a measured invasion of stroma of 4 mm in depth and 6 mm in horizontal spread. What is the International Federation of Gynecology and Obstetrics (FIGO) stage of her cancer?
IA2
What is the rate of HPV infection clearance within two years in most women?
90%
What is associated with an increased risk of adenocarcinoma?
Genetic susceptibility
What is the primary method used for staging cervical cancer?
Clinical evaluation
What is the common site of distant metastases in cervical cancer?
Lung, liver, and bone
What is the association between oral contraceptive use and cervical cancer?
Increased risk with 5-9 years of use
What is the relative risk of cervical squamous cell carcinoma for women who had their first sexual intercourse at the age of 17 to 19 years compared to those who had their first sexual intercourse at a later age?
2.16
What group of women has higher mortality rates from cervical cancer?
Black women
What is the five-year survival rate for women with stage IA cervical cancer?
93%
A woman has a cervical lesion that is clinically identified as a 3 cm tumor. What is the International Federation of Gynecology and Obstetrics (FIGO) stage of her cancer?
IB1
What is the most significant factor impacting the prognosis of cervical cancer?
Lymph node status
A woman has a cervical lesion that is identified as invasive cancer with a measured invasion of stroma of 2 mm in depth and 3 mm in horizontal spread. What is the International Federation of Gynecology and Obstetrics (FIGO) stage of her cancer?
IA1
What is the relative risk of cervical squamous cell carcinoma for women who have had more than 5 sex partners compared to those who have had fewer sex partners?
2.98
What is the five-year survival rate for women with stage IB cervical cancer?
80%
A woman has a cervical lesion that is clinically identified as a 6 cm tumor. What is the International Federation of Gynecology and Obstetrics (FIGO) stage of her cancer?
IB2
What is a risk factor for cervical squamous cell carcinoma according to the American Family Physician?
Current oral contraceptive use
What is a risk factor for cervical squamous cell carcinoma according to the American Family Physician?
Low socioeconomic status
What is the benefit of adding bevacizumab (Avastin) to combination chemotherapy for women with cervical cancer?
Improved overall survival
Why should patients with cervical cancer be referred to regional cancer centers?
To benefit from centralized services and expertise
What is the SORT evidence rating system used for in cervical cancer management?
To rate the quality of patient-oriented evidence
What is the significance of the disease stage in cervical cancer prognosis?
It is a major factor in determining prognosis
What is the significance of LVSI in cervical cancer prognosis?
It is a moderate factor in determining prognosis
Study Notes
Cervical Cancer Overview
- 13,000 cases of cervical cancer are diagnosed annually, resulting in over 4,000 deaths.
- Women aged 40-49 years have the highest incidence of cervical cancer, with 14 cases per 100,000 women per year.
- 40% of women are older than 40 years at diagnosis.
Pathogenesis
- HPV is detected in 99.7% of squamous cell carcinomas and adenocarcinomas.
- There are 15 known oncogenic strains of HPV, with types 16 and 18 involved in 70% of cervical cancer cases.
- Most sexually active adults will be exposed to HPV, with over 50% of adults 20-24 years old currently infected.
- The immune system clears the virus within six months in 50% of women and within two years in up to 90% of women.
Risk Factors for Cervical Cancer
- Increased exposure to HPV or decreased ability to clear the virus immunologically.
- Smoking is associated with an increased risk of squamous cell carcinoma, but not adenocarcinoma.
- Genetic susceptibility to cervical cancer, with several genetic alterations implicated.
- Use of oral contraceptives for 5-9 years is associated with an increased risk of cervical cancer.
Staging of Cervical Cancer
- Cervical cancer is staged clinically before surgery using the International Federation of Gynecology and Obstetrics 2014 guideline.
- Staging is determined by tumor size, depth of invasion, spread into surrounding tissue, and distant metastases.
- Cervical cancer is the only gynecologic cancer staged clinically before surgery.
Prognosis
- Prognosis is impacted by stage, tumor volume, depth of cervical stromal invasion, metastases, and LVSI.
- Disease stage and lymph node status are the two most prognostic factors.
- Adding bevacizumab (Avastin) to combination chemotherapy can improve overall survival in women with recurrent, persistent, or metastatic cervical cancer.
Identify the risk factors associated with cervical squamous cell carcinoma and understand the International Federation of Gynecology and Obstetrics staging.
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