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Gynaecology > 1: Gynaecological Oncology - Cervical Cancer and Screening > Flashcards

1: Gynaecological Oncology - Cervical Cancer and Screening Flashcards

1
Q

What is cervical cancer

A

Neoplasia of the cervix

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2
Q

What age is peak incidence of cervical cancer

A

25-29

Or, >80

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3
Q

What is the main type of cervical cancer

A

Squamous cell carcinoma

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4
Q

What is the typical pre-cursor of cervical cancer

A

Cervical intra-epithelial neoplasia

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5
Q

What are 99% of cervical cancers caused by

A

HPV

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6
Q

What types of HPV cause cervical cancer

A

HPV 16, 18 ,31 and 33

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7
Q

What are 5 risk factors for cervical cancer

A
  1. HPV
  2. Long-term smoking
  3. COCP > 8-years
  4. Immunosuppression
  5. STIs
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8
Q

How does cervical cancer present in the early stages

A

Asymptomatic

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9
Q

What is the most common symptom of cervical cancer

A

Abnormal bleeding

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10
Q

What defines abnormal bleeding

A
  • Intermenstrual bleed
  • Postcoital bleed
  • Post-menopausal bleed
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11
Q

How will vaginal discharge present in cervical cancer

A

Blood stained and malodorous

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12
Q

What are other symptoms of cervical cancer

A

Lower abdominal pain
Weight loss
Dyspareunia

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13
Q

How does cervical cancer present clinically

A
  • Blood stained discharge
  • Abnormal bleeding
  • Pelvic pain
  • Weight loss
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14
Q

What defines invasive cervical cancer opposed to CIN

A

Invades through basement membrane

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15
Q

What are the 4 most-commons sites of cervical cancer metastases

A

Bone
Bowel
Liver
Lung

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16
Q

Explain investigation for cervical cancer in pre-menopausal women

A
  1. Vulvovaginal swab for chlamydia
    - If positive treat
  2. If negative. colposcopy and biopsy
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17
Q

Explain investigation for cervical cancer in post-menopausal women

A

Urgent colposcopy and biopsy

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18
Q

What blood tests may be ordered in cervical cancer

A

FBC
LFT
U+E

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19
Q

What imaging may be ordered in cervical cancer

A

CT CAP

Pelvic MRI

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20
Q

What system is used to stage cervical cancer

A

FIGO

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21
Q

What is FIGO stage 0

A

CIN

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22
Q

What is FIGO stage 1

A

Cervical cancer within the cervix

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23
Q

What is FIGO stage 2

A

Cervical cancer beyond the cervix - but not in the lower third of the the vagina or pelvic side-wall

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24
Q

What is FIGO stage 3

A

Cervical cancer beyond the cervix in the lower third of the vagina or pelvic side wall

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25
Q

What is FIGO stage 3a

A

Cervical cancer in lower third of the vagina

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26
Q

What is FIGO stage 3b

A

Cervical cancer in pelvic side wall

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27
Q

What is FIGO stage 4

A

Cervical cancer extended to other organs

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28
Q

What is FIGO stage 4a

A

Cervical cancer to bladder or rectum

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29
Q

What is FIGO stage 4b

A

Cervical cancer to distant organs

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30
Q

What is FIGO stage 1a

A

Microscopic cervical cancer contained within cervix

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31
Q

How is FIGO stage 1a managed if wanting to preserve fertility

A

Trachelectomy

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32
Q

What is a trachelectomy

A

Removal cervix and upper-vagina

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33
Q

How is FIGO stage 1a managed if not wanting to preserve fertility

A

Laparoscopic hysterectomy with pelvic lymphadenopathy

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34
Q

What is FIGO stage 1b

A

Macroscopic cervical disease

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35
Q

How is FIGO stage 1b managed

A

Wetheim’s hysterectomy

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36
Q

What is Wertheim’s hysterectomy also known as

A

Radical hysterectomy

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37
Q

What is involved in radical hysterectomy

A

Following removed:

  • Uterus
  • Vagina
  • Parametrial tissue to pelvic side wall
  • Lymph nodes
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38
Q

How is FIGO stage 2a managed

A

Radical hysterectomy

39
Q

How is FIGO stage 2b managed

A

Chemotherapy

40
Q

How is FIGO stage 3 managed

A

Chemoradiotherapy

41
Q

How is FIGO stage 4 managed

A

Pelvic exenteration

42
Q

What is extenuation

A

Removal organs pelvic cavity

43
Q

What is gold-standard stage 1b to 3 and why

A

Chemotherapy.

Hysterectomy shown to have no benefit

44
Q

Explain vaccination to prevent HPV

A

Gardasil is given to 12-13 year-old boys and girls. Second dose repeated 24m afterwards

45
Q

What are 4 consequences of HPV

A
  • Cervical cancer (99%)
  • Anal cancer (80%)
  • Vulval or vaginal cancer (50%)
  • Mouth and throat cancer (30%)
46
Q

what is the aim of screening

A

to identify cervical intraepithelial neoplasia

47
Q

what age-group is the cervical screening program offered to

A

24.5-64 years

48
Q

when are individuals first invited to screening

A

24

49
Q

how often are 25-50 year-olds screened

A

every 3-years

50
Q

how often are every 50-64 year-olds screened for cervical cancer

A

every 5-years

51
Q

when are over 65-years screened for cervical cancer

A

If:
- Haven’t had screening test since 50-years and request
one
- Previous abnormal cytology result

52
Q

if an individual is HIV positive, how often are the screened for cervical cancer

A

Annually

53
Q

what are 4 contraindications to cervical smear test

A
  • Menstruating
  • <12W post-partum
  • <12W post-TOP or miscarriage
  • Vaginal discharge
54
Q

what is first-step of cervical smear

A

Speculum and cervical smear is sent of liquid based cytology (LBC)

55
Q

how are women classified based on liquid based cytology

A

Based on dyskaryosis:

  • Borderline
  • Mild dyskaroysis
  • Moderate dyskaryosis
  • Sevre dyskaryosis
  • Invasive
  • Abnormal glandular cells
56
Q

what happens to women with borderline or mild dyskaryosis

A

Send for high-risk HPV testing

57
Q

what happens to women with moderate or severe dyskaryosis

A

Send for colposcopy

58
Q

what happens to women with suspected invasion or abnormal glandular cells

A

Send for colposcopy

59
Q

if inadequate smear, what should be done

A

Repeat smear

60
Q

if a patient has 3 inadequate smears, what should be done

A

Send for colposcopy

61
Q

which patient’s are tested for HPV

A

Patients with borderline or mild dyskaryosis

62
Q

what is the test for HPV called

A

High-risk HPV testing

63
Q

if patients are HR-HPV +ve what is done

A

Send for colposcopy

64
Q

if patients are HR-HPV negative what is done

A

Re-enter screening

65
Q

which patients are referred to colposcopy

A
  • 3 inadequate smears
  • HR-HPV
  • > Moderate Dyskaryosis
66
Q

what is colposcopy used to identify

A

CIN

67
Q

what is CIN graded on

A

Depth of invasion

68
Q

what is CIN 1

A

<1/3 thickness cervical wall

69
Q

what is CIN 2

A

2/3 thickness cervical wall

70
Q

what is CIN 3

A

Full-thickness cervical wall

71
Q

What is risk CIN 2 and CIN 3

A

Progress to cervical cancer

72
Q

What are oncogenic types of cervical cancer

A

16, 18, 31, 33

73
Q

What increases risk of HPV

A

COCP

Multiple sexual partners

74
Q

Why is long-term COCP use associated with increased risk HPV

A

Due to decreased condom use

75
Q

How does management of CIN vary

A

Depending on grade

76
Q

What is a low-grade CIN

A

CIN 1

77
Q

What is grade-1 CIN

A

Less than 1/3 thickness of the cervix

78
Q

How is low-grade CIN managed

A

Colposcopy every 6-months

79
Q

What % of those with CIN 2 progress to cervical cancer

A

2-3

80
Q

What % with CIN 3 will progress to cervical cancer

A

20-30

81
Q

How is high-grade CIN managed

A

LLETZ (large-loop excision transition zone)

82
Q

What are 5 complications of LLETZ

A 
Haemorrhage 
Infection 
Vaso-vagal 
Cervical stenosis 
Risk pre-mature birth on subsequent pregnancies
83
Q

After LLETZ when are women followed-up

A

LBC at 6m

84
Q

If negative, borderline or mild dyskaryosis on follow-up what happens to women

A

HR-HPV

85
Q

If HR-HPV negative when is women invited for screening

A

3-years (independent of age)

86
Q

If HR-HPV positive on screening, what happens to the women

A

Colposcopy

87
Q

What does CGIN stand for

A

cervical glandular intraepithelial neoplasia

88
Q

What is CGIN

A

pre-cancer to endocervix adenocarcinoma

89
Q

How is CGIN managed

A

LLETZ
Cone biopsy
Hysterectomy = if family complete

90
Q

On colposcopy what stain is used to identify malignant cells

A

5% acetic acid

91
Q

On colposcopy what stain is used to identify non-malignant cells

A

Lugol’s iodine

92
Q

On colposcopy what stain is used to identify malignant cells

A

5% acetic acid

93
Q

On colposcopy what stain is used to identify non-malignant cells

A

Lugol’s iodine

Gynaecology (22 decks)

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