204.3 🩺 內科專科考前版

204.3.0.1 1⃣ Cervical Cancer Elimination (WHO 2030)

  • 90/70/90 strategy:
    • 90% girls vaccinated by 15 yr
    • 70% women screened by 35 + 45 yr (twice)
    • 90% of cervical pre-cancer + cancer treated
  • Mass vaccination + screening
  • Several countries on track (Australia, Sweden, Rwanda)
  • Lower-income countries challenged

204.3.0.2 2⃣ HPV Primary Testing — Why Preferred

  • More sensitive than cytology
  • Reduces over-diagnosis of low-grade lesions
  • Less frequent screening with negative result
  • Limited by cost + availability in some settings

204.3.0.3 3⃣ 27-45 yr Vaccination — Shared Decision

  • Lower efficacy vs early vaccination (some prior exposure)
  • Still beneficial for new infection prevention
  • Cost-benefit analysis
  • 通垞 sexually active women + men in this age range

204.3.0.4 4⃣ Pediatric Vaccine Hesitancy

  • Common concerns: “promotes early sex”, side effects
  • Counter:
    • No increase in sexual activity post-vaccination
    • Extensive safety data
    • Cancer prevention
  • Pediatrician shared decision-making

204.3.0.5 5⃣ Oropharyngeal Cancer Rising

  • HPV-16 driven (90%+)
  • Replaced traditional H&N CA in many regions
  • Tonsil + base of tongue
  • Patients: younger, non-smoker, non-drinker
  • HPV+ OPSCC better prognosis than HPV-
  • TNM staging now incorporates HPV status

204.3.0.6 6⃣ Anal Screening + ANCHOR

  • HIV+ MSM: anal cytology + HRA
  • ANCHOR 2024: AIN 2-3 treatment improves outcomes
  • Standard of care for HIV+
  • Expanded screening recommendations

204.3.0.7 7⃣ 健保 / Taiwan

  • 公費 HPV vaccine (2-dose for 12-13 yr girls 2018-, expanded)
  • 健保 cervical Pap smear
  • HPV primary testing — emerging
  • 公費 cervical CA screening
  • 男孩 vaccine 自費 — case for universal extending

204.3.0.8 8⃣ Pembrolizumab in Cervical CA

  • KEYNOTE-826 trial (NEJM 2021)
  • Pembrolizumab + chemotherapy (paclitaxel + cisplatin/carboplatin + bevacizumab) for advanced cervical CA
  • Improved overall survival vs chemo alone
  • Approved for advanced + PD-L1+ cervical CA

204.3.0.9 9⃣ Genital Wart Treatment Choice

  • Patient preference + lesion characteristics
  • Imiquimod: self-applied; immune-mediated clearance
  • Podophyllotoxin: self-applied; antimitotic
  • Cryotherapy: provider-applied; quick
  • Surgical: large / refractory
  • TCA: small lesions
  • 倚 lesions / immunocompromise = surgical / multimodal

204.3.0.10 10. RRP Treatment Updates

  • Multiple surgical recurrences (every 2-6 wk in severe)
  • Bevacizumab off-label — reduces recurrence frequency
  • Cidofovir intralesional
  • HPV-6/11 mRNA vaccines in trials (therapeutic)
  • Tracheostomy in airway obstruction (avoided when possible)