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PATH2220 > 15 - Cervical cancer > Flashcards

15 - Cervical cancer Flashcards

1
Q

Ectocervix

A

lined by non-keratinising
squamous epithelium

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2
Q

Endocervix

A

lined by mucinous columnar
epithelium

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3
Q

Squamo-columnar junction

A

The point at which the
squamous and columnar epithelium meet

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4
Q

What causes the position of the squamo-columnar junction to change

A

Hormonal influences, moved out to ectocervix in young adult

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5
Q

Transformation zone

A
  • Portion of columnar epithelium that is ultimately replaced by squamous epithelium
  • Where precancerous lesions and squamous carcinomas develop
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6
Q

Human Papillomavirus (HPV)

A
  • Accounts for more than 99% of cervical cancers
  • Common STI
  • Infects basal cells present at the transition zone
  • Requires damage to surface squamous cells to
    give access to immature basal cells
  • Most infections transient, asymptomatic and eliminated by host immune response
  • Persistent infection increases the risk of precancerous lesions and subsequent carcinoma
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7
Q

Risk factors of HPV

A
  • Age at first intercourse
  • Multiple sexual partners
  • Impaired immune response
  • Smoking
  • Coexisting infections
  • Lack of regular screening
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8
Q

HPV subtypes

A
  • At least 100 types of HPV
  • Divided into low and high oncogenic risk categories
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9
Q

High risk types of HPV

A

HPV 16 and 18, causing dysplasia and cancer. High Grade Squamous Intraepithelial Lesion

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10
Q

Low risk types of HPV

A

HPV 6 and 11, causing genital warts. Low Grade Squamous
Intraepithelial Lesion

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11
Q

Other body areas which can be affected by HPV

A
  • Anogenital tract
  • Oral cavity
  • Upper respiratory tract
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12
Q

Clinical presentation of cervical cancer

A
  • Most asymptomatic
  • Abnormal pap smear
  • Abnormal bleeding or vaginal discharge
  • Pain
  • Bladder symptoms
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13
Q

Macroscopic findings

A
  • Early lesions visible only on colposcopy
  • Focal induration, ulceration, elevated granular area that bleeds on touch
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14
Q

Types of advanced lesions

A
  • Endophytic: ulcerated
  • Exophytic: polypoid tumour mass
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15
Q

Cervical cancer subtypes

A
  • Squamous cell carcinoma
  • Adenocarinoma
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16
Q

Precursor lesion of squamous cell carcinoma

A

cervical intraepithelial neoplasia

17
Q

Precursor lesion of adenocarcinoma

A

Adenocarcinoma in situ

18
Q

Uncommon cervical tumours

A
  • Adenosquamous carcinoma
  • Direct invasion via malignancies from
    other organs (uterus, rectum, bladder)
  • Metastasis (breast, ovary)
19
Q

Squamous cell carcinoma

A

Malignant squamous epithelium invading
through basement membrane into stroma

20
Q

How is squamous cell carcinoma graded

A

Graded as well, moderate, or poorly differentiated depending on how easily the
“squamous” nature of the cells can be detected

21
Q

Adenocarcinoma

A
  • Proliferation of malignant cells showing glandular differentiation
  • Usually moderately or well differentiated
  • Multiple variants
22
Q

Spread of invasive carcinoma

A
  • Advanced tumours extend by direct spread to involve adjacent tissues (bladder, ureters, rectum, and
    vagina)
  • Local pelvic and distant lymph nodes
  • Distant metastases (liver, lungs, bone marrow etc)
23
Q

Prognosis and survival

A

Most patients with advanced cervical cancer die due to local extension of the tumour rather than distant metastases

24
Q

Treatment of cervical cancer

A
  • Early invasive carcinomas can be treated with cone biopsy only
  • Most invasive lesions treated with hysterectomy and lymph node dissection
  • Advanced lesions treated with surgery, radiotherapy and chemotherapy
25
Q

Identifying precursor lesions

A
  • Pap smear
  • Colposcopy
  • Cervical punch biopsy
  • Cone biopsy/LLETZ
26
Q

Pap smear

A
  • Cells from transformation
    zone obtained via
    spatula or brush
  • Smeared onto slide and
    stained using Papanicolaou method
  • Washed into a liquid based medium
  • Screened by a scientist
27
Q

Quadrivalenet HPV vaccine

A

HPV 6,11,16 and 18

28
Q

Bivalent HPV vaccine

A

HPV 16 and 18

29
Q

HPV Vaccine

A
  • Vaccine prepared from non-infectious virus-like particles
  • Induces serum antibodies to HPV
  • Protection for up to 5 years
30
Q

Is routine pap testing still needed

A
  • Vaccination will not protect against all cervical cancers
  • Vaccination will not protect against preexisting HPV infection
31
Q

CIN

A

Cervical intraepithelial neoplasia

32
Q

LSIL

A

Low grade Squamous Intraepithelial lesion

32
Q

HSIL

A

High grade Squamous
Intraepithelial lesion

PATH2220 (33 decks)

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