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Obstetrics and gynaecology > Cervical cancer > Flashcards

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
Q

List some differentials for abnormal vaginal bleeding

A 
STI
Cervical ectropion
Polyp
Fibroids
Pregnancy related bleeding
26
Q

What investigations should you do for a woman presenting with symptoms suggestive of cervical cancer?

A

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
Q

Which staging system is used for cervical cancer?

28
Q

Describe the FIGO staging system for cervical cancer

A

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
Q

What does management of cervical cancer consider?

A 
Stage 
Co-morbidities
Fertility issues 
MDT input 
Treatment options
30
Q

What is the availability of surgical options dependent on?

A

The stage of cancer

31
Q

What is the treatment for stage 1 a

A

Radical trachelectomy if fertility preservation is a priority
Laparoscopic hysterectomy with pelvic lymphadenectomy
Chemoradiation therapy - cisplatin based

32
Q

What is the treatment for stage 1b/2a

A

Radical (Wertheims) hysterectomy as curative treatment plus lymphadenectomy
Chemoradiation therapy - cisplatin based

33
Q

What is the treatment for stage 4a or recurrent disease

A

Anterior/posterior/total pelvic extenteration

Removal of all pelvic adnexae plus bladder and rectum

34
Q

Describe the follow up of cervical cancer

A

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
Q

What is cervical intraepithelial neoplasia?

A

Grading system for the level of dysplasia in the cells of the cervix

36
Q

What is dysplasia

A

Premalignant change

37
Q

How is CIN diagnosed?

A

Colposcopy

38
Q

What are the grades of CIN

A

CIN 1
CIN 2
CIN 3

39
Q

Describe CIN 1

A

Mild dysplasia, affecting 1/3 thickness of the epithelial layer, likely to return to normal without treatment

40
Q

Describe CIN 2

A

Moderate dysplasia, affecting 2/3 thickness of the epithelial layer, likely to progress to cancer if untreated

41
Q

Describe CIN 3

A

Severe dysplasia, very likely to progress to cancer if untreated

42
Q

What is CIN 3 sometimes called?

A

Cervical carcinoma in situ

43
Q

How is cervical cancer screened for?

A

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
Q

What is dyskaryosis

A

Precancerous changes within the cells

45
Q

When are the cells examined in a cervical smear?

A

If the high risk hPV is positive

46
Q

Describe the age and frequency of cervical screening

A

Every 3 years 25-49

Every 5 years 50-64

47
Q

Describe the management of an inadequate smear sample

A

Reat after 3 months

48
Q

Describe the management of HPV negative smear

A

Continue routine screening

49
Q

Describe the management of HPV positive with normal cytology

A

Repeat HPV test after 12 months

50
Q

Describe the management of HPV with abnormal cytology

A

Refer for colposcopy

51
Q

What is colposcopy

A 
Speculum and colposcope used to magnify the cervix
Special stain (acetic acid and iodine solution) used to differentiate abnormal areas
52
Q

What colour does acetic acid stain abnormal cells

A

White (acetowhite)

53
Q

When does acetowhite occur

A

In cells with increased nuclear to cytoplasmic ratio - more nuclear material - such as CIN and cervical cancer cells

54
Q

Describe Schillers iodine test

A

Iodine solution used to stain cells of the cervix - stains healthy cells a brown colour and abnormal areas do not stain

55
Q

What can be done during colposcopy to get tissue samples?

A

Punch biopsy

Large loop excision of the transformational zone

56
Q

Describe large loop excision of the transformation zone (LLETZ)

A

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
Q

What can LLETZ procedure increase the risk of

A

Preterm labour depending on the depth of tissue removed

58
Q

What is a cone biopsy?

A

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
Q

What are the main risks of a cone biopsy

A

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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