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Obs & Gynae > Cervical and Vulva Cancer > Flashcards

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
Q

What are RF for CIN

A

Smoking

Immunodeficiency

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26
Q

What will immunodeficient have

A

Low grade CIN

Only treat if high grade

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27
Q

How is CIN Dx

A

HPV detected on smear

Dx by cytology

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28
Q

How do you prevent CIN and what HPV causes

A

Vaccination
6+11 = warts
16+18 = cancer
Screening

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29
Q

How do you Rx CIN if discovered

A 
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
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30
Q

What do you do after RX

A

6 month follow up smear for test of cure

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31
Q

If smear comes back normal

A

Back to regular recall

32
Q

Can you be HPV +ve but normal smear

A

Yes as body hasn’t cleared virus

33
Q

What will happen if don’t treat CIN

A

Progress to cancer

34
Q

What type of cancer is cervical

A

SCC = 70%

Adenocarcinoma rising

35
Q

What causes cervical cancer

A 
HPV = 99.7%
16+18 = highest risk
36
Q

What other cancer can HPV cause

A

Anal
Penis
Vulval
Head and neck

37
Q

How is cervical stages

A 
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
Q

How does cervical cancer present

A

Abnormal vaginal bleeding - PCB / IMB / PMB
Discharge
Abnormal cervix

39
Q

If higher stage how does it present

A

Renal failure / hydronephrosis if spread to ureter (3)
- Consider nephrostomy
Pelvic pain = unusual
Pressure Sx - bowel / bladder

40
Q

What may speculum show

A

Red, lumpy, ulcerated cervix

41
Q

Where does cervical cancer spread too

A

Lymphatic to pelvic node
Liver
Lung
Bone

42
Q

What increases risk of cervical cancer

A 
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
Q

How do you Dx

A

Clinical
Pelvic and speculum
Biopsy

44
Q

What do you do if pre-menopausal

A

C+G

45
Q

What do you do if post menopausal

A

Refer to PMB clinic

46
Q

How do you stage

A

EUA for pelvis and rectum
MRI = 1st line
PET CT

47
Q

How do you treat 1A

A

Same as CIN
- Cone biopsy increases risk of pre-term
Maintain fertility
Hysterectomy is gold standard and close follow up advised

48
Q

How do you treat 1b-2A

A

Radical hysterectomy with pelvic LN dissection
RT before to shrink
- Brachy therapy or external beam
Chemo resistant but maybe use if LN +Ve

49
Q

How do you treat 2b-4

A

Chemo + RT

Hysterectomy after if possible

50
Q

How do you follow up

A

4 monthly for 2 years

Hx and speculum as no cervix

51
Q

What do you do if 1A or CIN

A

6 + 12 monthly smear
Then annual for 4 years
Then national

52
Q

What is a radical hysterectomy and complication

A

Remove uterus, cervix, upper vagina, parametria
Pelvic and para-aortic nodes

Bleeding
Damage to local
Infection
Anaesthetic
Urethral fistula
53
Q

What is parametria

A

Blood and lymphatics

54
Q

What are complications of cervical cancer treatment

A

Bone marrow suppression
Orgasm / libido

Short term RT
Diarrhoea
Vaginal bleeding 
Radiation burn
Tiredness / weak

Chronic RT
Ovarian failure
Lymphoedema
Fibrosis of organs

55
Q

What is lymph oedema

A 
Increased circumference
Fullness
Change in sensation
Reduced flexibility
Palpable skin
56
Q

How do you treat lymph oedema

A

Compression
Good skin care
Exercise

57
Q

What causes VIN

A

Type 1 = HPV, younger onset

Type 2 = older women, associated lichen sclerosis

58
Q

How does VIN present

A 
Severe intractable itch
Raised plaque
Erosion
Nodules
Warty growth
Kerototic rough
Sharp border
Erythematous
White
Brown
59
Q

What are RF for VIN

A 
Same as CIN
HPV
Smokong 
Other STI 
Other malignancy
Immunosuppression
60
Q

How do you Dx

A

Punch biopsy

Presents symptomatic

61
Q

How do you treat

A

Surgery - WLE

62
Q

What is topical treatment

A

Imiquimoid

Preserve function but risk of recurrence

63
Q

What els can be done

A

Laser ablation

May miss

64
Q

How do you follow up

A

Clinic

Colposcopy

65
Q

What type of cancer is vulval

A

SCC
BCC
Melanom
Bartholins gland

66
Q

Ho does vulval present

A 
Severe unretractable itch
Pain
Burn
Bleeding 
Lump or ulcer on vulval
Lymphadenopathy
67
Q

What are RF for vulval cancer

A

Age
HPV
VIN
Lichen sclerosis

68
Q

How do you Rx

A

Surgery
RT / chemo
Groin node dissection - do SNB before

69
Q

How does vulval spread

A

Inguinal and upper femoral node

Pelvic

70
Q

What are complications of groin node dissection

A

Wound infection
Lymphocyst
Nerve damage

71
Q

How often are people who are HIV +Ve screened for cervical cancer

A

At diagnsosis and annually

72
Q

What is Lichen sclerosis

A

Chronic autoimmune inflammatory condition which affects elderly female

73
Q

How does it present

A 
Itch = prominent 
Painful sore tight skin
Dyspareunia 
Skin appears porcelain white, tight and skin
May have papule or plaque
74
Q

How do you Dx

A

Clinical

Biopsy if suspect VIN / vulval cancer

75
Q

What are complications

A

Pain
Bleeding
Narrowing of vaginal opening
Increased risk of vulval cancer / VIN

76
Q

How do you Rx

A

Topical steroid

Regular emollient

Obs & Gynae (23 decks)

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