Cancers Flashcards
Types of Cervical Cancers? (2)
histology of cervix?
- Squamous cell carcinoma 80%
- adenocarcinoma 10%
Risks of Cervical Cancer (9)
most common? (2)
- HPV 16 & 18.
- Inadequate cervical screening.
- Multiple Sexual Partners
- partner has HPV
- multiple pregnancies
- Smoking
- FHx (first degree relative)
- HIV
- Use of COCP more than 5 years!
association of HPV w. Cervical C
They are thought to produce proteins which inhibit the tumour suppressor protein p53 in cervical epithelial cells, allowing for uncontrolled cell division.
Prevention of Cervical Cancer (4)
1) Encourage women to participate in the (NHS-CSP)
2) Encourage girls aged 12–13 years get vaccine for HPV (Gardasil®)
3) safe sex and the use of condoms.
4) Limiting the number of sexual partners–>reduces HPV
Gardasil prevents against 6, 11, 16, 18
symptoms for cervical cancer (4)
signs (3)
Alarm symptoms ofc
- Abnormal vaginal bleeding (intermenstrual, postcoital or post-menopausal bleeding)
- Vaginal discharge
- Pelvic pain
- Dyspareunia
Signs:
- Speculum examination – assess for evidence of bleeding, discharge and ulceration.
- Bimanual examination – assess for pelvic masses.
- GI examination – assess for hydronephrosis, hepatomegaly, rectal bleeding, mass on PR.
Examination findings cervical cancer (2)
On examination:
- The cervix: inflamed or friable and bleed on contact
- There may be a visible ulcerating or fungating lesion or a foul-smelling serosanguineous vaginal discharge.
Screening for Cervical Cancer
- Who is screened and how often? (3)*
- in those who r HIV +?*
Women aged 25-64
- 25-49 years – 3 yearly screening
- 50-64 years – 5 yearly screening
- Over 65 – invited if
- HIV + - smear EVERY YR
- Recent cervical cytology abnormal
- On request and no cervical screening since 50
what does the screening consist of for Cervical C? (2)
what r the circumstances in which cervical screening should be delayed? (3)
-
Visualisation of the cervix with speculum:
* change from pale, pink, shiny ectocervix—>red, glandular appearance of the cervix - Cervical smear w/ collect cells via soft brush
- Sample taken from the whole of the transformation zone
- Primary HPV testing - test for HPV FIRSST.
- If HPV + –> refer Cytology - detects changes in cervical cells through microscopy
Delayed:
- Menstruation
- Vaginal discharge/infection
- 3 months post partum
interpretation of screening
What does dyskaryosis mean?
Smear results
- Normal - no further action and continue screening programme
- HPV + ——> do cytology
Cytology results:
►No abnormal cells – come back 1 yr for smear
(is after another year, hpv still + and cytolgoy -, come back after another year again, if after 24 mnths still same, then refer colposcopy)
►Abnormal:
- Mild dyskaryosis (CIN I) – continue routine screening
- Moderate dyskaryosis (CIN II) – refer to COLPOSCOPY under 2WW pathway
- Severe dyskaryosis (CIN III) – suspected cancer, refer to colposcopy under 2WW pathway
►Inadequate – repeat smear after 3 mnths
§ Reasons – presence of blood on the smear, cervical inflammation, age-related atrophic changes
Dyskaryosis: abnormal nucleus
Inadequate sample ?
HPV - ?
HPV + w/ normal cytology ?
HPV + w/ abnormal cytology?
Inadequate sample – repeat smear after 3 months
HPV negative – continue routine screening
HPV positive with normal cytology – repeat the HPV test after 1 yr
HPV positive with abnormal cytology – refer for colposcopy
Treatment for CIN
complications of it? 3
CIN and early-stage 1A: LLETZ or cone biopsy
It can be performed with a LA during a colposcopy procedure. It involves using a loop of wire with electrical current (diathermy) to remove abnormal epithelial tissue on the cervix. The electrical current cauterises the tissue and stops bleeding.
Bleeding and abnormal discharge can occur for several weeks following a LLETZ procedure.
Pyometra( uterine infectiion) intercourse and tampon use should be avoided after the procedure.
Depending on the depth of the tissue removed from the cervix, the procedure may increase the risk of preterm labour or miscarriage
Treatment for Cervical Cancer (3)
- according to stages ofc*
- what about In women who are pregnant?*
- Stage 1B – 2A: Radical hysterectomy and removal of Lymphadenectomy with chemo and radio
- Stage 2B – 4A: Chemo and radio
- Stage 4B: Management may involve a combo of Sx, radio, chemo and palliative care
- In women who are pregnant:*
- Care from the MDT and delivery after 35 weeks is the treatment of choice.*
Investigations for Cervical Cancer
Endometrial cancer
Rfx (7)
patient’s exposure to UNOPPOSED oestrogen.
- early menarche & late menopause
- nullparity
- HRT
- TAMOXIFEN >> anti-oestrogenic effect on breast tissue, but oestrogenic effect on the endometrium
- Obesity (aromatase enzyme converts adrogens to estrogen
- PCOS >> lots of follicles being made, still producing lots of estrogen and no progesterone being made
- lynch syndrome
Endometrial cancer
sign and symtoms
any woman presenting with postmenopausal bleeding has endometrial cancer until proven otherwise!!
On examination:
- Abdominal– for abdominal or pelvic masses.
- Speculum– for evidence of vulval/vaginal atrophy, or cervical lesions.
- Bimanual– to assess the size & axis of the uterus prior to endometrial sampling.
Symptoms:
- PMB
- intermenstrual bleeds
- abnormal vaginal discharge
Endometrial cancer treatment
Total abdominal hysterectomy and bilateral salpingo-oophorectomy
Staging endometrial Cancer
FIGO staging
Stage I – Carcinoma confined uterus
Stage II – Carcinoma may extend to cervix but is not beyond the uterus.
Stage III – Carcinoma extends beyond uterus but is confined to the pelvis.
Stage IV – Carcinoma involves bladder or bowel, or has metastasised to distant sites.
what is Lynch syndrome?
whic cancers r is it assoc. w/?
also known as hereditary non-polyposis colorectal cancer (HNPCC)
see the “hen” alaa? LOL
Other causes of raised CA-125
- Peritoneal trauma, disease, or irritation.
- primary peritoneal cancer, lung cancer, and pancreatic cancer
- Endometriosis
- PID
- Ovarian cysts/torsion/rupture/hemmorhage
- Heart failure
- Liver disease
