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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
What is FIGO stage 3a
Cervical cancer in lower third of the vagina
26
What is FIGO stage 3b
Cervical cancer in pelvic side wall
27
What is FIGO stage 4
Cervical cancer extended to other organs
28
What is FIGO stage 4a
Cervical cancer to bladder or rectum
29
What is FIGO stage 4b
Cervical cancer to distant organs
30
What is FIGO stage 1a
Microscopic cervical cancer contained within cervix
31
How is FIGO stage 1a managed if wanting to preserve fertility
Trachelectomy
32
What is a trachelectomy
Removal cervix and upper-vagina
33
How is FIGO stage 1a managed if not wanting to preserve fertility
Laparoscopic hysterectomy with pelvic lymphadenopathy
34
What is FIGO stage 1b
Macroscopic cervical disease
35
How is FIGO stage 1b managed
Wetheim's hysterectomy
36
What is Wertheim's hysterectomy also known as
Radical hysterectomy
37
What is involved in radical hysterectomy
Following removed: - Uterus - Vagina - Parametrial tissue to pelvic side wall - Lymph nodes
38
How is FIGO stage 2a managed
Radical hysterectomy
39
How is FIGO stage 2b managed
Chemotherapy
40
How is FIGO stage 3 managed
Chemoradiotherapy
41
How is FIGO stage 4 managed
Pelvic exenteration
42
What is extenuation
Removal organs pelvic cavity
43
What is gold-standard stage 1b to 3 and why
Chemotherapy. | Hysterectomy shown to have no benefit
44
Explain vaccination to prevent HPV
Gardasil is given to 12-13 year-old boys and girls. Second dose repeated 24m afterwards
45
What are 4 consequences of HPV
- Cervical cancer (99%) - Anal cancer (80%) - Vulval or vaginal cancer (50%) - Mouth and throat cancer (30%)
46
what is the aim of screening
to identify cervical intraepithelial neoplasia
47
what age-group is the cervical screening program offered to
24.5-64 years
48
when are individuals first invited to screening
24
49
how often are 25-50 year-olds screened
every 3-years
50
how often are every 50-64 year-olds screened for cervical cancer
every 5-years
51
when are over 65-years screened for cervical cancer
If: - Haven't had screening test since 50-years and request one - Previous abnormal cytology result
52
if an individual is HIV positive, how often are the screened for cervical cancer
Annually
53
what are 4 contraindications to cervical smear test
- Menstruating - <12W post-partum - <12W post-TOP or miscarriage - Vaginal discharge
54
what is first-step of cervical smear
Speculum and cervical smear is sent of liquid based cytology (LBC)
55
how are women classified based on liquid based cytology
Based on dyskaryosis: - Borderline - Mild dyskaroysis - Moderate dyskaryosis - Sevre dyskaryosis - Invasive - Abnormal glandular cells
56
what happens to women with borderline or mild dyskaryosis
Send for high-risk HPV testing
57
what happens to women with moderate or severe dyskaryosis
Send for colposcopy
58
what happens to women with suspected invasion or abnormal glandular cells
Send for colposcopy
59
if inadequate smear, what should be done
Repeat smear
60
if a patient has 3 inadequate smears, what should be done
Send for colposcopy
61
which patient's are tested for HPV
Patients with borderline or mild dyskaryosis
62
what is the test for HPV called
High-risk HPV testing
63
if patients are HR-HPV +ve what is done
Send for colposcopy
64
if patients are HR-HPV negative what is done
Re-enter screening
65
which patients are referred to colposcopy
- 3 inadequate smears - HR-HPV - >Moderate Dyskaryosis
66
what is colposcopy used to identify
CIN
67
what is CIN graded on
Depth of invasion
68
what is CIN 1
<1/3 thickness cervical wall
69
what is CIN 2
2/3 thickness cervical wall
70
what is CIN 3
Full-thickness cervical wall
71
What is risk CIN 2 and CIN 3
Progress to cervical cancer
72
What are oncogenic types of cervical cancer
16, 18, 31, 33
73
What increases risk of HPV
COCP | Multiple sexual partners
74
Why is long-term COCP use associated with increased risk HPV
Due to decreased condom use
75
How does management of CIN vary
Depending on grade
76
What is a low-grade CIN
CIN 1
77
What is grade-1 CIN
Less than 1/3 thickness of the cervix
78
How is low-grade CIN managed
Colposcopy every 6-months
79
What % of those with CIN 2 progress to cervical cancer
2-3
80
What % with CIN 3 will progress to cervical cancer
20-30
81
How is high-grade CIN managed
LLETZ (large-loop excision transition zone)
82
What are 5 complications of LLETZ
``` Haemorrhage Infection Vaso-vagal Cervical stenosis Risk pre-mature birth on subsequent pregnancies ```
83
After LLETZ when are women followed-up
LBC at 6m
84
If negative, borderline or mild dyskaryosis on follow-up what happens to women
HR-HPV
85
If HR-HPV negative when is women invited for screening
3-years (independent of age)
86
If HR-HPV positive on screening, what happens to the women
Colposcopy
87
What does CGIN stand for
cervical glandular intraepithelial neoplasia
88
What is CGIN
pre-cancer to endocervix adenocarcinoma
89
How is CGIN managed
LLETZ Cone biopsy Hysterectomy = if family complete
90
On colposcopy what stain is used to identify malignant cells
5% acetic acid
91
On colposcopy what stain is used to identify non-malignant cells
Lugol's iodine
92
On colposcopy what stain is used to identify malignant cells
5% acetic acid
93
On colposcopy what stain is used to identify non-malignant cells
Lugol's iodine

Gynaecology (22 decks)

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