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Cervical and Vulva Cancer Flashcards

1
Q

What is the aim of cervical screening

A

Look for abnormal growth of squamous cells

Pre-cancerous changes - CIN

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2
Q

Why is adenocarcinoma under detected

A

Can’t screen as don’t know how it behaves

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3
Q

Who gets cervical screening

A

Women 25-64
3 yearly smear
5 yearly after 50

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4
Q

Who gets unscheduled smear

How often if HIV +Ve

A

Not recommended
Unless immunocompromised
Annual smear if HIV

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5
Q

What is a smear test

A

Microscopic detection of abnormal squamous cells suggesting underlying CIN

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6
Q

When do you refer to gynae

A

Can’t visualise cervix
Cervical stenosis
Symptomatic

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7
Q

What do you do if symptomatic

A

Urgent colposcopy 2 weeks

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8
Q

What do you do if pregnancy and smear due

A

Wait 12 weeks post partum if normal in past
Specialist if abnormal smear in the past
Can be performed as long as no CI i.e. low lying placenta

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9
Q

What does the smear test involve

A

Liquid based cytology sample taken from transformation zone in cervix
Speculum exam

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10
Q

What has transformation zone in it

A

Sqaumo-columnar junction

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11
Q

Histology of transformation zone

A

Stratified squamous line vagina
Glandular / columnar lines cervix
At puberty / pill / pregnancy due to oestrogen cervix increases in size and junction moves down
Forms ectropion
Columnar doesn’t like vagina Metaplasia to squamous
New junction further up
Junction retracts after menopause

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12
Q

What happens with smear test

A

HPV test on all cells
If -ve recall in 3 years
If +ve cytology

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13
Q

What happens with cytology

A

Looks for abnormal cells (dyskaryosis) indicating CIN - only biopsy can tell
If -ve do HPV test again in 1 year
If +ve = colposcopy

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14
Q

If borderline / low grade result

A

Repeat 6 months or colposcopy

If 3 strikes = colposcopy

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15
Q

If unsatisfactory result

A

Repeat test in 3 months

3 strikes = colposcopy

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16
Q

If moderate / high grade

A

Urgent colposcopy in 2 weeks

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17
Q

What happens at colposcopy

A

Malignification and light
Exclude obvious malignancy
Acetic acid to detect CIN and select biopsy site
Punch biopsy which is sent to lab

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18
Q

What else can be done at colposcopy

A

LLETZ if CIN

NOT if still want family as risk of pre-term

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19
Q

What do you do if bleeding

A

Test for C+G

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20
Q

If biopsy shows CIN2/3 or looks particular high grade what do you do

A

Treat

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21
Q

What suggests dyskaryosis

A 
Disarray in arrangement
Irregular 
Increased size
Large nucleus 
Increased nucleus / cytoplasm ratio
Smaller cell
Variation in size / shape 
Coarse irregular chromatin
Prominent dark nuclei
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22
Q

What does high grade dyskaryosis suggest

A

High grade HPV

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23
Q

What is HPV

A

A virus that causes abnormal growth of squamous cells
90% clear
If persist develop CIN

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24
Q

What is CIN

A

Abnormal cells contained within BM

Pre-cancer

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25
What are RF for CIN
Smoking | Immunodeficiency
26
What will immunodeficient have
Low grade CIN | Only treat if high grade
27
How is CIN Dx
HPV detected on smear | Dx by cytology
28
How do you prevent CIN and what HPV causes
Vaccination 6+11 = warts 16+18 = cancer Screening
29
How do you Rx CIN if discovered
``` Excise or ablate transition zone LLETZ = 1st line Thermal Laser Cone biopsy with -ve margins to remove Can all be done at colposcopy under GA Biopsy does not require LA ```
30
What do you do after RX
6 month follow up smear for test of cure
31
If smear comes back normal
Back to regular recall
32
Can you be HPV +ve but normal smear
Yes as body hasn't cleared virus
33
What will happen if don't treat CIN
Progress to cancer
34
What type of cancer is cervical
SCC = 70% | Adenocarcinoma rising
35
What causes cervical cancer
``` HPV = 99.7% 16+18 = highest risk ```
36
What other cancer can HPV cause
Anal Penis Vulval Head and neck
37
How is cervical stages
``` FIGO 1a = microscopic invasive - only seen on microscopy 1b = confined to cervix 2a = upper vagina 2b = parametrium 3 = lower vagina + pelvic wall 4 = bladder and rectum ```
38
How does cervical cancer present
Abnormal vaginal bleeding - PCB / IMB / PMB Discharge Abnormal cervix
39
If higher stage how does it present
Renal failure / hydronephrosis if spread to ureter (3) - Consider nephrostomy Pelvic pain = unusual Pressure Sx - bowel / bladder
40
What may speculum show
Red, lumpy, ulcerated cervix
41
Where does cervical cancer spread too
Lymphatic to pelvic node Liver Lung Bone
42
What increases risk of cervical cancer
``` HPV Smoking - 2 fold HIV / other STI Prolonged COCP Early age of intercourse as higher risk of HPV Multiple partner Age Immunodeficient Persistent infection with HPV High parity ```
43
How do you Dx
Clinical Pelvic and speculum Biopsy
44
What do you do if pre-menopausal
C+G
45
What do you do if post menopausal
Refer to PMB clinic
46
How do you stage
EUA for pelvis and rectum MRI = 1st line PET CT
47
How do you treat 1A
Same as CIN - Cone biopsy increases risk of pre-term Maintain fertility Hysterectomy is gold standard and close follow up advised
48
How do you treat 1b-2A
Radical hysterectomy with pelvic LN dissection RT before to shrink - Brachy therapy or external beam Chemo resistant but maybe use if LN +Ve
49
How do you treat 2b-4
Chemo + RT | Hysterectomy after if possible
50
How do you follow up
4 monthly for 2 years | Hx and speculum as no cervix
51
What do you do if 1A or CIN
6 + 12 monthly smear Then annual for 4 years Then national
52
What is a radical hysterectomy and complication
Remove uterus, cervix, upper vagina, parametria Pelvic and para-aortic nodes ``` Bleeding Damage to local Infection Anaesthetic Urethral fistula ```
53
What is parametria
Blood and lymphatics
54
What are complications of cervical cancer treatment
Bone marrow suppression Orgasm / libido ``` Short term RT Diarrhoea Vaginal bleeding Radiation burn Tiredness / weak ``` Chronic RT Ovarian failure Lymphoedema Fibrosis of organs
55
What is lymph oedema
``` Increased circumference Fullness Change in sensation Reduced flexibility Palpable skin ```
56
How do you treat lymph oedema
Compression Good skin care Exercise
57
What causes VIN
Type 1 = HPV, younger onset | Type 2 = older women, associated lichen sclerosis
58
How does VIN present
``` Severe intractable itch Raised plaque Erosion Nodules Warty growth Kerototic rough Sharp border Erythematous White Brown ```
59
What are RF for VIN
``` Same as CIN HPV Smokong Other STI Other malignancy Immunosuppression ```
60
How do you Dx
Punch biopsy | Presents symptomatic
61
How do you treat
Surgery - WLE
62
What is topical treatment
Imiquimoid | Preserve function but risk of recurrence
63
What els can be done
Laser ablation | May miss
64
How do you follow up
Clinic | Colposcopy
65
What type of cancer is vulval
SCC BCC Melanom Bartholins gland
66
Ho does vulval present
``` Severe unretractable itch Pain Burn Bleeding Lump or ulcer on vulval Lymphadenopathy ```
67
What are RF for vulval cancer
Age HPV VIN Lichen sclerosis
68
How do you Rx
Surgery RT / chemo Groin node dissection - do SNB before
69
How does vulval spread
Inguinal and upper femoral node | Pelvic
70
What are complications of groin node dissection
Wound infection Lymphocyst Nerve damage
71
How often are people who are HIV +Ve screened for cervical cancer
At diagnsosis and annually
72
What is Lichen sclerosis
Chronic autoimmune inflammatory condition which affects elderly female
73
How does it present
``` Itch = prominent Painful sore tight skin Dyspareunia Skin appears porcelain white, tight and skin May have papule or plaque ```
74
How do you Dx
Clinical | Biopsy if suspect VIN / vulval cancer
75
What are complications
Pain Bleeding Narrowing of vaginal opening Increased risk of vulval cancer / VIN
76
How do you Rx
Topical steroid | Regular emollient

Obs & Gynae (23 decks)

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