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Cervical cancer Flashcards

1
Q

What is cervical cancer?

A

Neoplasia arising from the cervix - the lower part of the uterus

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2
Q

What is the peak age of diagnosis of cervical cancer?

A

25-29

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3
Q

What type of cancer are cervical cancers?

A

Squamous cell carcinoma
Adenocarcinoma
Mixed

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4
Q

What does cervical cancer develop from?

A

Progression from cervical intraepithelial neoplasia

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5
Q

What timeframe does CIN develop over?

A

10-20 years

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6
Q

What happens to most CIN?

A

Spontaneously regress - not all progress to cancer

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7
Q

When does invasive cervical cancer occur?

A

When the basement membrane of the epithelium has been breached

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8
Q

Name the most common sites of metastasis

A

Lung
Liver
Bone
Bowel

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9
Q

What are most cervical cancers caused by?

A

Human papillomavirus

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10
Q

What percentage of cancer cells contain HPV DNA in the cells

A

99/7%

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11
Q

How is HPV transmitted?

A

Sexually

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12
Q

How many different HPV types affect the genital area?

A

30

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13
Q

What does HPV affect?

A

Skin and mucous membranes

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14
Q

What percentage of women are thought to be infected with HPV at some point?

A

80%

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15
Q

How long does it take the immune system to clear HPV infection?

A

2 years

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16
Q

Which HPV types cause genital warts?

A

6 and 11

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17
Q

What are the two high risk serotypes of HPV?

A

16 and 18

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18
Q

Describe how HPV 16 and 18 are high risk

A

Thought to produce proteins which inhibit the tumour suppressor protein p53 in cervical epithelial cells, allowing for uncontrolled cell division

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19
Q

Which HPV serotypes does the HPV vaccination protect against?

A

16, 18, 6, 11

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20
Q

What percentage reduction in cervical cancer has screening and vaccination thought to account for

A

40%

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21
Q

List some risk factors for cervical cancer

A 
HPV
Smoking
STIs
Long term >8yr combined oral contraceptive pill use
Immunodeficiency
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22
Q

List the symptoms of cervical cancer

A

Abnormal vaginal bleeding - post coital, intermenstrual, post-menopausal
Vaginal discharge - blood stained, foul smelling
Dyspareunia
Pelvic pain
Weight loss

Advanced disease - oedema, loin pain, rectal bleeding, radiculopathy, haematuria

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23
Q

Where is most cases of cervical cancer detected?

A

Routine screening

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24
Q

Describe the examination of cervical cancer

A

Speculum - evidence of bleeding, discharge and ulceration
Bimanual exam - pelvic masses
GI examination - hydro nephrosis, hepatomegaly, rectal bleeding, mass on PR

25
List some differentials for abnormal vaginal bleeding
``` STI Cervical ectropion Polyp Fibroids Pregnancy related bleeding ```
26
What investigations should you do for a woman presenting with symptoms suggestive of cervical cancer?
Pre-menopausal - test for chlamydia trachomatis, refer for colposcopy and biopsy if negative or if symptoms persist Post-menopausal - Urgent colposcopy and biopsy Basic bloods - FBC, LFT, U&Es CT-CAP- look for metastases Further staging scans - MRI pelvis, PET +/- examination under anaesthesia with further biopsies
27
Which staging system is used for cervical cancer?
FIGO
28
Describe the FIGO staging system for cervical cancer
Stage 0 - carcinoma in situ Stage 1 - confined to cervix Stage 2 - beyond cervix but not pelvic sidewall/involves vagina but not lower 1/3 Stage 3 - Extends to pelvic sidewall/involves lower 1/3 vagina/hydro nephrosis not explained by another cause Stage 4 - Extends to bladder or rectum or metastases
29
What does management of cervical cancer consider?
``` Stage Co-morbidities Fertility issues MDT input Treatment options ```
30
What is the availability of surgical options dependent on?
The stage of cancer
31
What is the treatment for stage 1 a
Radical trachelectomy if fertility preservation is a priority Laparoscopic hysterectomy with pelvic lymphadenectomy Chemoradiation therapy - cisplatin based
32
What is the treatment for stage 1b/2a
Radical (Wertheims) hysterectomy as curative treatment plus lymphadenectomy Chemoradiation therapy - cisplatin based
33
What is the treatment for stage 4a or recurrent disease
Anterior/posterior/total pelvic extenteration | Removal of all pelvic adnexae plus bladder and rectum
34
Describe the follow up of cervical cancer
Gynae review every 4 months after treatment for first 2 year and every 6-12 months for subsequent 3 years Physical examination of vagina and cervix
35
What is cervical intraepithelial neoplasia?
Grading system for the level of dysplasia in the cells of the cervix
36
What is dysplasia
Premalignant change
37
How is CIN diagnosed?
Colposcopy
38
What are the grades of CIN
CIN 1 CIN 2 CIN 3
39
Describe CIN 1
Mild dysplasia, affecting 1/3 thickness of the epithelial layer, likely to return to normal without treatment
40
Describe CIN 2
Moderate dysplasia, affecting 2/3 thickness of the epithelial layer, likely to progress to cancer if untreated
41
Describe CIN 3
Severe dysplasia, very likely to progress to cancer if untreated
42
What is CIN 3 sometimes called?
Cervical carcinoma in situ
43
How is cervical cancer screened for?
Cervical smear - aims to pick up precancerous changes in epithelial cells on the cervix Speculum examination and collection of cells from the cervix using a small brush The cells are deposited from the brush into a preservation fluid Fluid is transported to a lab where the cells are examined under a microscope for precancerous changes Samples tested for high risk hPV before cells are examined.
44
What is dyskaryosis
Precancerous changes within the cells
45
When are the cells examined in a cervical smear?
If the high risk hPV is positive
46
Describe the age and frequency of cervical screening
Every 3 years 25-49 | Every 5 years 50-64
47
Describe the management of an inadequate smear sample
Reat after 3 months
48
Describe the management of HPV negative smear
Continue routine screening
49
Describe the management of HPV positive with normal cytology
Repeat HPV test after 12 months
50
Describe the management of HPV with abnormal cytology
Refer for colposcopy
51
What is colposcopy
``` Speculum and colposcope used to magnify the cervix Special stain (acetic acid and iodine solution) used to differentiate abnormal areas ```
52
What colour does acetic acid stain abnormal cells
White (acetowhite)
53
When does acetowhite occur
In cells with increased nuclear to cytoplasmic ratio - more nuclear material - such as CIN and cervical cancer cells
54
Describe Schillers iodine test
Iodine solution used to stain cells of the cervix - stains healthy cells a brown colour and abnormal areas do not stain
55
What can be done during colposcopy to get tissue samples?
Punch biopsy | Large loop excision of the transformational zone
56
Describe large loop excision of the transformation zone (LLETZ)
LA during colposcopy Loop of wire with electrical current (diathermy) to remove abnormal epithelial tissue on the cervix Electrical current cauterises the tissue and stops bleeding Bleeding and abnormal discharge can occur for several weeks following LLETZ procedure
57
What can LLETZ procedure increase the risk of
Preterm labour depending on the depth of tissue removed
58
What is a cone biopsy?
Treatment for CIN and very early stage cervical cancer GA Cone shaped piece of cervix removed with a scalpel Sample sent for histology to assess for malignancy
59
What are the main risks of a cone biopsy
Pain Bleeding Infection Scar formation with stenosis of the cervix Increased risk of miscarriage and premature labour

Obstetrics and gynaecology (67 decks)

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