carcinoma of the cervix Flashcards
commonest causes of cancer in women that cause mortality
breast
lung
bowel
uterus
ovary
most common cancer in women under 35
cervical squamous carcinoma
risk factors for cervical cancer
early age at first intercourse
multiple sexual partners
male partner with previous multiple partners
smoking
HIV virus
high parity
5 years use or more of COCP
low socioeconomic status
most common subtype for cervical cancer
16,18,33 ( 31,35,47)
all types of cervical carcinoma believed to be associated with HPV
how does HPV act to cause carcinoma
infects the basal cells of squamous epithelium and then the products of virus ( E6 and 7 ) inhibit tumour suppressor genes p53 and RB protein inducing malignant transformation
what is cervical intraepithelial neoplasia
precancerous changes in cervical squamous epithelium
3 grades ranging from basal layer dyplasia to full thickness dysplasia of epithelium
mild moderate and severe dyskaryosib predict minimum abnormality
associated with koilocytosis ( seen in smears) - with warts - clearing oc cytoplasm of infected cells making a hollow appearance
32yr old woman investigated fro post coital bleeding. bleeding for about 1 years nearly every time after sex. little blood. periods were regular and docent use contraception.
pelvic pain dull fro 6 months
slightly incontient of urine for year
smoked 20 cigareetesad a day
last cervical smear was 10 years ago
two alarms - pelvic pain and incontinence - malignancy. smoking is a cofactors for cervical cancer too
what do we this
pleomorphic cells - different in size shape etc
patient has MRI showing stage 3 carcinoma of cervix
tumour big involving lower uterus and extension to eight parametric. pelvic lymphadenopathy and lung mets
went chemo radiotherapy and died about 1 year later
30yr old gynaecologist outpatients for prolonged PV bleeding
daily for last 4 months
laparoscopic sterilisation 2years ago
smear showed sever dyskaryosib - previous 5yr ago from - referred to urgent colposcopy and loop wedge biopsy performed
CIN 2-3 in storm of a gland
total hysteromy and no recurrence
she couldn’t understand why it hadn’t been picked up on her screening program - screening is not absolute safeguard no perfect - single smear may not be representative , mass miss the one cell and lack familiarity to the eye , poor follow ups and poor compliance or just a misdiagnosed
what HPV virus is common fro genital warts
6,11
how are abnormal smears followed up
BNC(borderline smear) what happens
repeat in 6 months
refer on 3rd abnormality
glandular abnroamlieis same above and adenocarcinoma is refer
CIN 1 on cytology smear what follow up
repeat in 6 months if under 35
refer on 2nd abrnomalit
refer if over 35
CIN 2 and CIN 3 found what happens
referred for colposcopy
what is the cervical smear screening test what ages and how often
24-64
every 3yr if 25-49
every 5yr from 50-64
If HPV positive and normal cytology then what is follow up
12 months
what is the treatment for CIN 2 and 3
large loop excision of transformation zone
should all women over the age of 55 with postmenopausal bleeding be referred urgently to gynaecology
yes
neoplasia
abnormal mass/proliferation of cells
dysplasia
morphologic maisfestation of esrly neoplastic changec
cannot invade or met
carcinoma
malignant tumour of epithelial cells
ecto-cervical is squamous epi
what is endo-cervical
glandular epi - secretes
CGIN turns into
adenocarcinoma
whereas CIN turns into SCC
same treatment for both
HHPV 6 and 11 cause
genital warts
dyskaryosis
abnormal looking cell
mild - CIN 1
moderate - 2
severe - 3
if HPV positive - test 12 month
what happens if test postiive 3 times
refer to colposcopy
LLETZ
3-4mm around SCJ - transformation zone - cold cone biopsy
if not sure what lesion is what will help
P16 immunohistochemistry- antibodie sto hceck - p16 is a surrgoate for hrHPV
systomatic cervical cancer presents as
post coital or intermenstrual bleeding refer to gynae
persistent unexplained vaginal discharge
systomatic cervical cancer presents as
post coital or intermenstrual bleeding refer to gynae
persistent unexplained vaginal discharge
FIGO staging of cervical cancer
0- in situ but also known as CIN
1 - confined to cervix
2 - beyond cervix but no to pelvic wall or lower vag
30 disease to pelvic wall or lower 1/3 of vag
4- invades bladder rectum or mets
chemo from third
HPV driven carcinomas
vulva
vagina
penis
anus
oropharynx
