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A - MSRA Cancer Care [1] > [28] Cervical Cancer > Flashcards

[28] Cervical Cancer Flashcards

1
Q

What is cervical cancer?

A

Cancer arising from the cervix

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2
Q

What is the most common type of cervical cancer?

A

Squamous cell carcinoma

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3
Q

How does cervical cancer compare to other cancers in terms of prevalence worldwide?

A

3rd most commonly diagnosed world wide

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4
Q

How does cervical cancer compare to other cancers as causes of cancer deaths in women?

A

4th most common

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5
Q

How many new cases of cervical cancer are there each year in the UK?

A

3000

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6
Q

How many cervical cancer deaths are there each year in the UK?

A

850

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7
Q

How common is cervical cancer in women in the UK?

A

14th most common cancer in females

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8
Q

What % of cervical cancer cases in the UK are considered preventable?

A

99.8%

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9
Q

What is the most common age range for diagnosis of cervical cancer?

A

25-34 years old

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10
Q

What % of cervical cancers are squamous cell carcinomas?

A

70%

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11
Q

What are the other types of cervical cancer?

A
  • Mixed pattern (15%)

- Adenocarcinoma (15%)

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12
Q

What stages of disease can all subtypes of cervical cancer causes?

A

Pre-invasive and invasive

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13
Q

How do most cases of cervical cancer progress to invasive disease?

A

From HPV infection to CIN to invasive disease

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14
Q

What does CIN stand for?

A

Cervical intraepithelial neoplasia

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15
Q

What is CIN?

A

A cytological diagnosis describing involvement of the epidermis

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16
Q

What are the subtypes of CIN?

A

CIN I-III

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17
Q

What is CIN I?

A

Disease confined to the lower 1/3 of the epithelium

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18
Q

What happens to most cases of CIN I?

A

They regress slowly (some progress)

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19
Q

What is CIN II?

A

Disease confined to the lower and middle thirds of the epithelium

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20
Q

What is CIN III?

A

Disease affecting the full thickness of the epithelium

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21
Q

What % of CIN III progress to invasive carcinoma within 2-10 years?

A

10%

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22
Q

What % of CIN III will regress spontaneously?

A

30%

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23
Q

How long does progression from CIN I to III take approximately?

A

7 years

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24
Q

What is invasive cervical cancer?

A

Where there is breach of the epithelial basement membrane at any point

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25
Q

What can invasive cervical cancer be divided into?

A
  • Micro-invasive carcinoma

- Invasive carcinoma

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26
Q

What is micro-invasive carcinoma of the cervix?

A

Deepest invasive element is <5mm from the surface of the epithelium

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27
Q

What is invasive carcinoma of the cervix?

A

Deepest invasive element is >5mm from the surface of the epithelium or >7mm wide

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28
Q

What does invasive carcinoma of the cervix require in terms of assessment?

A

Formal staging

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29
Q

What is the most important risk factor for cervical cancer?

A

Presence of HPV infection

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30
Q

What % of cervical tumours have HPV infection involved?

A

99%

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31
Q

What are the most high risk types of HPV in terms of cervical cancer?

A

16 and 18

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32
Q

What % of cervical cancer have HPV 16/18 involved?

A

70%

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33
Q

What are some other risk factors for cervical cancer?

A
  • Heterosexual women
  • Women with multiple sexual partners
  • Partners of promiscuous males
  • Smoking
  • Lower social class
  • Immunosuppression
  • Long term use of OCP
  • Non-attendance at cervical screening programme
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34
Q

What is the aim of the cervical screening programme?

A

To detect CIN in the asymptomatic population to reduce mortality and morbidity

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35
Q

How is cervical cancer screening performed?

A

Insert speculum to view the squamocolumnar junction of the cervix and rotate brush against it to take cells for liquid based cytology

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36
Q

How are the cells taken on cervical cancer screening analysed?

A

Look for abnormalities of the nucleus and other aspects of cell morphology

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37
Q

How can the results of cervical cancer screening be classified?

A
  • Negative
  • Inadequate
  • Borderline
  • Mild dyskaryosis
  • Moderate dyskaryosis
  • Severe dyskaryosis
  • Glandular neoplasia
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38
Q

What % of cervical cancer screening tests are negative?

A

94%

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39
Q

What can cause an inadequate cervical cancer screening result?

A
  • Insufficient materials sampled
  • Unlabelled specimens
  • Inadequate fixation/poor spreading on the material
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40
Q

What is a borderline cervical cancer screening result?

A

Cells with abnormal nuclei but cannot say for certain if they display dyskaryosis

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41
Q

What does mild dyskaryosis usually equate to?

A

CIN I

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42
Q

What does moderate dyskaryosis usually equate to?

A

CIN II

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43
Q

What doe severe dyskaryosis usually equate to?

A

CIN III

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44
Q

What percent of cervical smears show glandular neoplasia?

A

0.1%

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45
Q

What does glandular neoplasia indicate?

A

Abnormalities of glandular cells suggestive of adenocarcinoma in situ/of cervix/ endometrial adenocarcinoma or other organ

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46
Q

How should a negative cervical screening result be managed?

A
  • Investigate any incidental findings
  • Ensure patient is informed
  • Recall as appropriate for age and previous history
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47
Q

How should inadequate cervical screening results be managed?

A
  • Repeat sample as soon as possible

- If persistent advise for colposcopy

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48
Q

How should borderline and mild dyskaryosis results be managed?

A
  • Test for HPV
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49
Q

If HPV test for borderline or mild cervical screening results is negative, how should this be managed?

A

Return to normal recall

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50
Q

If HPV test for borderline or mild cervical screening results is positive how should this be managed?

A

Refer for colposcopy

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51
Q

How should moderate or severe dyskaryosis cervical screening result be handled?

A

Refer for colposcopy

52
Q

What will women that have been treated for abnormal cervical screening result be followed up?

A

‘Test of cure’ 6 months after treatment

53
Q

What is involved in a test for following abnormal cervical screening?

A
  • HPV test

- Cytology of smear

54
Q

What happens if 6 months recall HPV test is positive or there is moderate/severe dyskaryosis?

A

Back to colposcopy

55
Q

What happens if 6 months recall HPV is negative?

A

Normal recall

56
Q

What screening frequency is given following a CIN I?

A
  • Repeat at 6 months
  • Repeat at 12 months
  • Yearly for 2 years
57
Q

What screening frequency is given following a CIN II and III?

A
  • Repeat at 6 months
  • Repeat at 12 months
  • Yearly for 8 years
58
Q

What screening frequency is given following invasive disease?

A
  • Repeat at 3 months
  • Repeat at 6 months
  • 6 monthly for 5 years
59
Q

How are most cases of cervical cancer detected?

A

By screening

60
Q

What are the symptoms of CIN and micro-invasive disease?

61
Q

What are the symptoms of early stage invasive cervical cancer?

A
  • Abnormal vaginal bleeding
  • Vaginal discharge
  • Vaginal discomfort/urinary symptoms
62
Q

What sort of bleeding can occur in early invasive cervical cancer?

A
  • Spontaneous
  • Post-coital
  • After micturition or defecation
63
Q

How can vaginal discharge due to early invasive cervical cancer vary?

A
  • In volume

- Intermittent or continuous

64
Q

What are the symptoms of late cervical cancer?

A
  • Painless haematuria
  • Chronic urinary frequency
  • Painless fresh rectal bleeding
  • Altered bowel habit
65
Q

What are the signs of early stage cervical cancer?

A

Usually relatively normal

66
Q

What are the potential examination findings of cervical cancer?

A
  • White or red patches on the cervix
  • Rectal examination may reveal mass or bleeding
  • Bimanual palpation may show pelvic mass
  • Leg oedema may develop
  • Hepatomegaly
67
Q

Why can cervical cancer lead to white or red patches on the cervix?

A

Due to erosion, ulcer or tumour

68
Q

Why may rectal examination show mass or bleeding in cervical cancer?

A

Due to erosion

69
Q

Why may bimanual examination show a mass in cervical cancer?

A

Due to pelvic spread

70
Q

Why may leg oedema develop in cervical cancer?

A

Due to lymphatic spread or vascular obstruction

71
Q

Why may cervical cancer cause hepatomegaly?

A

If liver mets

72
Q

When should a 2WW referral be made for cervical cancer?

A
  • Appearance consistent with cervical cancer
73
Q

Is a smear test required before referral for cervical cancer?

74
Q

Is a previous negative smear test a reason to delay referral for potential cervical cancer?

75
Q

What are the differentials for cervical cancer?

A
  • Cervicitis
  • Dysfunctional uterine bleeding
  • Cervical erosion (ectropion)
  • PID
  • Endometrial cancer
  • Side-effects of IUCD use
  • Endometrial hyperplasia
  • Fibroids
  • Atrophic vaginitis
76
Q

What examinations should be performed for symptoms suspicious of cervical cancer?

A
  • Pelvic examination

- Speculum

77
Q

What is the main investigation for suspected cervical cancer?

A

Colposcopy

78
Q

What does colposcopy allow for?

A

Examination of the entire cervix and the transformation zone

79
Q

What happens in colposcopy for cervical cancer?

A
  • Cervix cleaned with acetic acid
  • Inspection
  • Biopsy
  • Treatment if necessary
80
Q

What are the key diagnostic criteria for cervical cancer on colposcopy?

A
  • Abnormal vasculature
  • White change with acetic acid
  • Obvious exophytic lesions
81
Q

What other investigations may be undertaken for cervical cancer?

A
  • FBC, RFT, LFT
  • CT CAP with contrast
  • PET
  • Examination under anaesthesia
  • HPV testing
82
Q

What is a CT CAP used for in cervical cancer?

A

Assessing for mets

83
Q

What is a PET scan used for in cervical cancer?

84
Q

What examinations can be done under anaesthesia for cervical cancer?

A
  • Abdominal
  • Vaginal
  • Rectal
  • Colposcopy
  • Hysteroscopy
  • Cystoscopy
  • Sigmoidoscopy
  • Biopsy
85
Q

What staging system is most commonly used for cervical cancer?

86
Q

What is Stage 0 cervical cancer?

A

No evidence of primary tumour - so not cervical cancer

87
Q

What is Stage Tisb cervical cancer?

A

Carcinoma in-situ (pre-invasive)

88
Q

What is Stage I cervical cancer?

A

Carcinoma confined to the cervix

89
Q

What is Ia cervical cancer?

A

Invasive carcinoma diagnosed only by microscopy

90
Q

What is Ib cervical cancer?

A

Clinically visible lesions confined to the cervix

91
Q

What is Stage II cervical cancer?

A

Tumour invades beyond the cervix but not the pelvic muscles or ligaments or lower vagina

92
Q

What is IIa cervical cancer?

A

Cancer has spread into the top of the vagina

93
Q

What is IIb cervical cancer?

A

Tumour has gone above the cervix

94
Q

What is Stage III cervical cancer?

A

Cancer has spread into the surrounding pelvic structures (but not organs) or lower vagina

95
Q

What is IIIa cervical cancer?

A

Cancer in lower vagina but not pelvic wall

96
Q

What is IIIb cervical cancer?

A

Tumour is in the pelvic wall or blocking the ureter

97
Q

What is Stage IV cervical cancer?

A

Spread to other organs of the body e.g. rectum

98
Q

What is IVa cervical cancer?

A

Spread to nearby organs e.g. rectum

99
Q

What is IVb cervical cancer?

A

Spread to distant organs e.g. lungs

100
Q

What is the most important issue to consider when treating cervical cancer?

A

Potential to spare fertility as many patients are young

101
Q

What options are available for treating cervical cancer?

A
  • Surgery
  • Chemotherapy
  • Radiotherapy
102
Q

What are the main treatments for CIN I?

A

Follow-up or cryotherapy

103
Q

What is the treatment for CIN II or III?

A
  • Superficial excision with loop diathemy if confined to ectocervix
  • Loop biopsy for CIN III in cervical canal
104
Q

What is the treatment for Ia1 cervical cancer?

A

Conisation with free margins or simple hysterectomy depending on age and fertility choices

105
Q

What may be required if pathology shows positive margins after local excision of Ia1 cervical cancer?

A

Hysterectomy or chemoradiation

106
Q

What is the most commonly used chemotherapy agent in cervical cancer?

107
Q

What are the treatment options for Ia2 cervical cancer?

A

Local excision or extra-fascial hysterectomy

108
Q

What is the advantage of local excision over hysterectomy for micro-invasive cervical cancer?

A

It preserves fertility

109
Q

What would be considered early stage cervical cancer?

110
Q

What is the treatment for an early stage cervical cancer <2cm where fertility is to be preserved if cancer Ia2-Ib1?

A

Radical trachelectomy and lymphadenectomy

111
Q

What is the treatment for early stage cervical cancer >2cm and the patient is suitable for surgery?

A

Radical hysterectomy and lymphadenectomy

112
Q

What does radical hysterectomy include removal of?

A

Parametrial tissue and upper 1/3 of vagina

113
Q

What may be required for treatment of >2cm early stage cervical cancer if pathology shows positive nodes, involvement of the parametrium or position margins?

A

Post-op chemotherapy

114
Q

What is the preferred treatment for >4cm early stage cervical cancer?

A

Chemoradiation

115
Q

What treatment is given for early stage cervical cancer if tumour is between 2 and 4cm and patient is not suitable for surgery?

A

Chemoradiation

116
Q

What is locally advanced cervical cancer?

117
Q

What is the treatment for locally advanced cervical cancer?

A

Chemoradiation

118
Q

What is metastatic cervical cancer treated with?

A

Combination therapy

119
Q

What can be given if distant cervical cancer mets are isolated and amenable to local treatment?

A
  • Adjunctive surgery
  • Local ablative therapies
  • Adjunctive radiation
120
Q

What options are available if combination therapy for advanced or metastatic cervical cancer is not effective?

A
  • Single-agent chemotherapy
  • Clinical trial
  • Supportive care
121
Q

If a pregnant woman has cervical cancer and wants to keep her baby how should the pregnancy be dealt with?

A

MDT care and delivery after 35 weeks

122
Q

What treatment options are not safe in pregnancy for cervical cancer?

A
  • Radiotherapy

- Surgery is best avoided

123
Q

When is chemotherapy for cervical cancer safe in pregnancy?

A

Appears to be in 2nd and 3rd trimester but little data available

124
Q

What features of cervical cancer indicate a poorer prognosis?

A
  • Adenocarcinoma
  • Lymph node involvement
  • Advanced clinical stage
  • LArge primary tumour
  • Early recurrence
125
Q

What is the 5 year survival rate for Stage 1a cervical cancer?

126
Q

What is the 5 year survival rate for Stage 4 cervical cancer?

127
Q

Overall what % of people with cervical cancer survive for 10 years or more?

A - MSRA Cancer Care [1] (47 decks)

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