Cervical risk
•Which HPV subtypes cause ~2/3 of cervical cancers?
HPV 16 and 18
• HPV 16 and 18 are the most oncogenic strains and are responsible for most high-grade lesions and cancers.
•Earliest age HPV vaccination can be started?
Age 9
Vaccination before HPV exposure offers maximal protection.
•Immediate CIN3+ risk threshold for colposcopy?
≥4%
ASCCP guidelines are risk-based, not result-based.
•Most common symptom of endometrial cancer?
Postmenopausal bleeding
Occurs in ~90% of patients
•First-line test for postmenopausal bleeding?
TVUS or endometrial biopsy
Either acceptable depending on risk and availability.
•What percentage of cervical cancers are HPV-associated?
~99.7%
Virtually all cervical cancers are linked to persistent oncogenic HPV infection
•Preferred screening age 30–65 for average-risk patients?
Primary HPV testing every 5 years
USPSTF/ACOG prefer HPV-based screening due to higher sensitivity.
•When is expedited treatment preferred?
: Risk ≥60%
High probability of CIN3+ justifies treatment without biopsy.
•Greatest modifiable risk factor in US?
Obesity
Adipose tissue increases peripheral estrogen production.
•Which biopsy result mandates hysterectomy?
Endometrial hyperplasia with atypia (EIN)
High risk of progression to carcinoma.
Which immunocompromised condition increases progression risk >4x?
HIV infection
HIV impairs immune clearance of HPV, increasing persistence and malignant transformation
•Why no screening before age 21?
High spontaneous clearance & harm from overtreatment
Most HPV infections regress; procedures increase preterm birth risk.
•Normal colpo but glandular cytology → next step?
Endocervical curettage
Evaluates endocervical lesions not visible on ectocervix.
•Condition causing chronic unopposed estrogen?
PCOS
Anovulation leads to persistent endometrial stimulation.
•Why is ablation contraindicated in suspected cancer?
Masks pathology and delays diagnosis
Residual malignancy may persist undetected.
>10 years of OCP use confers what cervical cancer risk?
Relative risk ~2.2–2.5
Risk increases with duration of estrogen exposure, though benefits exist for other cancers.
Who age 27–45 should still get HPV vaccine?
High-risk individuals
Those with new partners or STI risk may benefit from protection against new strains.
•Best imaging for nodal metastases >10 mm?
FDG-PET
More sensitive than CT or MRI for lymph nodes.
•Type 1 vs Type 2 endometrial cancer: which has worse prognosis?
Type 2 (serous/clear cell)
Type 2 cancers are aggressive and hormone-independent.
•Why TVUS unreliable in premenopausal women?
Cyclic endometrial thickness variation
Thickness varies by menstrual phase.
Name two socioeconomic factors increasing cervical cancer risk.
Low socioeconomic status; low education level
These factors limit access to vaccination, screening, and follow-up.
•HPV vaccination after CIN treatment reduces recurrence by what %?
~59%
Acts as secondary prevention after excisional treatment.
•Fertility-sparing option for stage IA1 cervical cancer?
Cervical conization
Appropriate for microinvasive disease with negative margins.
•Protective factor against endometrial cancer? (Name one)
•Combined OCPs, LNG-IUD, parity
progestins counteract estrogen-driven proliferation.
•Persistent AUB despite benign biopsy → next step?
Repeat biopsy or further evaluation
Single negative biopsy does not rule out cancer.