3.1 Cervical Cancer Flashcards
What are the main two types of cervical cancer?
Squamous cell carcinoma (80%)
Adenocarcinoma
rarely small cell cancer
Other than cervical cancer what other cancer is HPV associated with?
anal, vulval, penile, mouth and throat cancer
What strains of HPV responsible for around 70% of cervical cancers?
type 16 and 18
no treatment for HPV infection, most resolve in a few years but some persist
What stain of HPV causes genital warts?
6 and 11
What is the name of the current HPV vaccine?
Gardasil
What are the tumour suppressor genes that get inhibited by HPV?
p53 and
pRb genes
How does HPV inhibit p53 and pRb tumour suppressor genes?
HPV produces proteins:
E6 inhibits p53
E7 inhibits pRb
What increases the risk of cervical cancer / what are the risk factors?
(ask these in a history)
Increased risk of catching HPV:
- early sexual activity
- increased number of partners
- sexual partners with more partners
- not using condoms
Non-engagement with screening (many are preventable when precancerous)
Other factors:
- smoking
- HIV
- COCP >5yrs
- increased number of fullterm pregnancies
- FHx
- exposure to diethylstilbestrol as a fetus (used pre 1971
How does cervical cancer present?
asymptomatic and picked up on smear or
non-specific Sx:
- abnormal vaginal bleeding (intermenstrual, postcoital, post-menopausal)
- abnormal discharge
- pelvic pain
- dyspareunia
What speculum appearances suggest cervical cancer / warrant colposcopy?
- ulceration
- inflammation
- bleeding
- visible tumour
What is a grading system for the level of dysplasia found from colposcopy?
CIN = cervical intraepithelial neoplasia
What is happening at each CIN grade?
CIN I: mild, 1/3 thickness, likely to normalise
CIN II: moderate, 2/3 thickness, likely to progress to Cx
CIN III: severe, full thick, very likely to progress
What is another names for CIN III?
cervical carcinoma in situ
Colposcopy looks for dysplasia (premalignant change), what do smear tests look at in cells if there is HPV risk?
cells are examined if HPV comes back positive, looking for:
dyskaryosis (precancerous change)
(essentially the same are dysplasia but Zero says it isn’t)
What age and how often for cervical screening?
every 3 years for 25-49 yrs old
every 5 yrs for 50-64
What are some excepts to the typical 3 or 5 yearly cervical screening programme pattern?
- HIV: annual
- > 65 may request if they have not had one since 50
- previous CIN require additional tests (e.g. test of cure after treatment)
- immunocompromised may have additional screening (e.g. dialysis, cytotoxic drugs or organ transplant)
- pregnant due a routine smear wait until 12 weeks post-partum
What words can come back to describe cytology results?
- Inadequate
- Normal
- Borderline changes
- Low-grade dyskaryosis
- High-grade dyskaryosis (moderate)
- High-grade dyskaryosis (severe)
- Possible invasive squamous cell carcinoma
- Possible glandular neoplasia
What types of organisms are often discover in women who have an IUD (coil)?
actinomycetes-like organisms
if asymptomatic do nothing, if Sx then remove coil
What is the PHE guidance on management according to smear results?
- Inadequate sample = repeat the smear after at least three months
- HPV negative = continue routine screening
- HPV positive and normal cytology = repeat the HPV test after 12 months
- HPV positive with abnormal cytology = refer for colposcopy
During colposcopy (magnification), what stains can be used to differentiate abnormal areas?
- acetic acid
- iodine solution (Schiller’s)
What does acetic acid show? How?
abnormal cells appear white “acetowhite”
- these cells have incase nuclear to cytoplasmic ratio (such as in CIN or Cx)
What does Schiller’s iodine test show?
abnormal areas will not stain
health areas with stain brown
How can you get a tissue sample during a colposcopy?
large loop excision of the transformational zone
