B8.055 Cervical Cancer Flashcards
who do you test for HPV?
women > 30
do not test before this because 60-80% of young people will have HPV, but will clear it before age 30
what is the cervical cancer risk of a patient who is 55 and has not had a pap in 10 years
higher risk than general population
relationship between HPV prevalence and cervical cancer incidence
high risk HPV types prevalent in those 15-29, and decreases with age
risk of cervical cancer increases with age
cervical cancer epidemiology
was once the leading cause of cancer death of women in the US, now is the most preventable of all female cancers
worldwide, 4th most common cancer in women
in US, not in top 10
age rage of those affected by cervical cancer
37% of cervical cancers occur in women who are 20-44
-24% between 35 and 44 (peak)
symptoms of cervical cancer
abnormal discharge (foul smelling) abnormal, irregular vaginal bleeding postcoital bleeding pain during intercourse post menopausal bleeding pelvic, back or leg pain cachexia
why can you get back or leg pain with cervical cancer?
locally advanced disease can grow to encapsulate the sciatic nerve and block the ureters
appearance of cervical cancer on speculum exam
fungating, exophytic, bloody
no normal cervix left in advance stages
why is bleeding one of the main symptoms of cervical cancer
abnormal blood vessels coat the surface of the tumor
treatment options for stage IA1 cervical cancer
cold knife cone (just cut out a specific area)
simple hysterectomy
treatment options for stage IA2- IB cervical cancer
radical hysterectomy
radiation
equivalent survival in these two methods
what is a radical hysterectomy
very wide margins
have to dissect out ureters, cut deep into posterior culdesac and bladder, and take upper 1/3 of the vagina
treatment options for stage bulky IB, IIA-IVA cervical cancer
radiation with concomitant chemo (cisplatin)
treatment options for stage IVB (metastatic) cervical cancer
chemo +/- bevacizumab (monoclonal ab against vegf)
how does cervical cancer typically spread
usually spreads locally, destroys tissue around it
very uncommonly can spread through lymphatics and hematogenously
stage IA
invasive carcinoma which can be diagnosed only by microscopy
stage IB
clinically visible lesions limited to the cervix uteri or pre-clinical cancer greater than stage IA
stage II
cervical cancer that invades beyond the uterus, but not to the pelvic wall or to the lower third of the vagina
stage III
tumor extends to the pelvic wall and.or involves lower third of the vagina and/or causes hydronephrosis or non-functioning kidney
stage IV
extension beyond true pelvis into bladder or rectum
process of cervical cancer screening
scrape a portion of the external cervix and internal cervical os
look at cytology for abnormalities
test for HPV in those > 30
why is cervical cancer incidence plateauing in the US
people who need to be screened aren’t being screened
-those who are often in the highest risk groups
what are risk factors for cervical dysplasia
immunosuppression
HIV
transplant
cofactors for invasive carcinoma
tobacco
OCPs
estrogen
other STDs
HPV oncoproteins
E6
E7
responsible for malignant transformations
function of E7
inactivates pRB (a tumor suppressor)
function of E6
induces proteolytic degradation of p53
appearance of HPV infected cells on histo
koilocytes
inflammatory cell infiltrate
how long does CIN take to turn into cervical cancer typically
10 years
describe the structure of HPV prophylactic vaccines
recombinant L1 capsid protein that form “virus like” particles
resemble native HPV particles
type specific
non-infectious and non-oncogenic, contain no DNA
produce higher levels of neutralizing Ab than natural infection
when should preteens start/ finish the HPV vaccine series AND who else should get it
can start at age 9
should finish the series by their 13th bday
+ girls 13-26 who havent started or finished the series
+ boys 13-21 who havent started for finished the series
which 3 vaccines can be given together to preteens
meningitis
HPV cancers
pertussis
