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Year Three - Reproductive System > Cervical Cancer > Flashcards

Cervical Cancer Flashcards

1
Q

What is cervical cancer?

A

It is defined as the proliferation of malignant cells in the cervical epithelium

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2
Q

What is the most common classification of cervical cancer?

A

Squamous cell carcinomas

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3
Q

What is the second most common classification of cervical cancer?

A

Adenocarcinoma

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4
Q

What is the pathophysiological cause of cervical cancer?

A

There is microtrauma to the cervical epithelial cells of the transformation zone, which provides human papilloma virus access to basal keratinocytes

It therefore infects these cells with its surface proteins and uses E6/E7 oncoproteins to inhibit the tumour suppressors p53 and pRb, resulting in uncontrolled cellular proliferation

This leads to pre-malignant cellular abnormalities – known as cervical intraepithelial neoplasia

It may progress to cervical cancer

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5
Q

What is cervical intraepithelial neoplasia (CIN)?

A

It is is defined as a premalignant dysplasia of the cervical epithelium, usually at the squamocolumnar junction, driven by infection with human papillomavirus (HPV)

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6
Q

What nine risk factors are associated with cervical cancer?

A

Young Aged, 15 – 44 Years Old

Human Papilloma Virus 16/18/33

Early First Intercourse

Multiple Sexual Partners

Sexually Transmitted Infections

Oral Contraceptive Use

Multiparity

Smoking

Low Socioeconomic Status

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7
Q

What are the five other high risk human papilloma virus infections associated with cervical cancer?

A

HPV 31

HPV 35

HPV 45

HPV 52

HPV 58

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8
Q

What are the five clinical features of cervical cancer?

A

Pelvic Pain

Abnormal Vaginal Bleeding

Abnormal Vaginal Discharge

Dyspareunia

Cervical Mass

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9
Q

What five investigations are used to diagnose cervical cancer?

A

Cervical Cancer Screening

Blood Tests

Cervical Swabs

Cervical Colposcopy

Pelvic MRI Scans

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10
Q

How is cervical screening used to investigate cervical cancer?

A

It is used to detect pre-malignant changes, in order to prevent progression of cervical intraepithelial neoplasia into cervical cancer

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11
Q

Who is offerred cervical cancer screening? How often?

A

All women between 24 – 64 years old

Every five years

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12
Q

What are the three exceptions to the usual cervical cancer screening schedule?

A

Pregnancy = delayed until three months postpartum unless missed screening or abnormal smears

HIV Patients = offerred cervical cytology at diagnosis, after which is offerred annually

CIN Patients = offerred 6 months after treatment for a test of cure repeat cervical sample in the community

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13
Q

How do we conduct cervical cancer screening?

A

It involves conduction of a cervical smear test, in which samples are taken from the transformation zone of the cervix

This sample is initially tested for high-risk strains of human papilloma virus (hrHPV), with cytological examination only being performed when this is positive

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14
Q

What are the three tests conducted on cervical smear samples?

A

High Risk HPV PCR Testing

Cervical Cytology

Cervical Colposcopy

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15
Q

What is high risk HPV PCR testing?

A

It involves testing for viral DNA of human papilloma virus strains 16/18/33 within the cervical sample

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16
Q

What is the most appropriate step when hrHPV results are negative?

A

The patient is returned to the normal recall of the screening programme

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17
Q

What is the most appropriate step when hrHPV results are positive?

A

The cervical smear sample should be examined cytologically

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18
Q

What is cervical cytology?

A

It involves examination of the cervical cells under the microscope in order to detect cellular abnormalities indicative of human papilloma virus infection

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19
Q

What is the feature of human papilloma virus on cervical cytology?

A

Koilocytes

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20
Q

What are the four features of koliocytes on cervical cytology?

A

Nucleus Enlargement

Irregular Nuclear Membrane Contour

Hyperchromasia

Perinuclear Halo

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21
Q

What is hyperchromasia?

A

It is defined as darker staining of the nucleus

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22
Q

What is the most appropriate step when hrHPV results are positive with normal cervical cytology?

A

The cervical smear test should be repeated at 12 months

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23
Q

What is the most appropriate step when repeat smear at 12 months is now hrHPV negative?

A

The patient should return to the normal recall of the screening programme

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24
Q

What is the most appropriate step when repeat smear at 12 months is still hrHPV positive with normal cervical cytology ?

A

The cervical smear test should be repeated at 12 months

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25
Q

What is the most appropriate step when repeat smear at 24 months is now hrHPV negative?

A

The patients should return to the normal recall of the screening programme

26
Q

What is the most appropriate step when repeat smear at 24 months is still hrHPV positive?

A

There should be conduction of colposcopy

27
Q

What is the most appropriate step when hrHPV results are positive with abnormal cervical cytology?

A

There should be conduction of colposcopy

28
Q

What is cervical colposcopy?

A

It involves insertion of a vaginal speculum and use of a colposcope device to magnify the cervix, enabling examination of cervical epithelial lining

29
Q

What is the most appropriate step when the cervical smear test is deemed as inadequate?

A

The cervical smear test should be repeated at 3 months

30
Q

What is the most appropriate step when the two consecutive cervical smear tests are deemed as inadequate?

A

There should be conduction of colposcopy

31
Q

What three blood test results indicate cervical cancer?

A

Decreased Haemoglobin Levels

Increased WBC Levels

Increased CRP Levels

32
Q

How are cervical swabs used to diagnose cervical cancer?

A

They are used to detect sexually transmitted infections, in order to rule out coinfection

33
Q

When is urgent cervical colposcopy used to diagnose cervical cancer?

A

It is used to investigate cervical cancer in individuals with visible suspicion of cervical cancer or persistent unexplained cervical features

34
Q

How are pelvic MRI scans used to diagnose cervical cancer?

A

They are used to stage cervical cancer, by detecting lymph node involvement and distant metastases

35
Q

What are the three criteria for a 2 week gynaecology referral for cervical cancer?

A

In postmenopausal women with unexplained vaginal bleeding

In premenopausal women with persistent intermenstrual bleeding and negative pelvic exam

In women with clinical features suggesting cervical cancer if they have not been screened or if the bleeding persists beyond three months

36
Q

What are the three stages of cervical intraepithelial neoplasia?

A

Cervical Intraepithelial Neoplasia One

Cervical Intraepithelial Neoplasia Two

Cervical Intraepithelial Neoplasia Three

37
Q

What is another term for cervical intraepithelial neoplasia one?

A

Low grade cervical lesions

38
Q

What is cervical intraepithelial neoplasia one?

A

It is defined as dysplasia occurring within the basal 1/3rd of cervical epithelium

39
Q

What is another term for cervical intraepithelial neoplasia two?

A

High grade cervical lesions

40
Q

What is cervical intraepithelial neoplasia two?

A

It is defined as dysplasia occurring within the basal 2/3rd of cervical epithelium

41
Q

What is another term for cervical intraepithelial neoplasia three?

A

Carcinoma-in-situ

42
Q

What is cervical intraepithelial neoplasia three?

A

It is defined as dysplasia occurring within more than 2/3rd of cervical epithelium – without invasion of the basement membrane

43
Q

What are the five stages of cervical cancer?

A

Cervical Cancer IA

Cervical Cancer IB

Cervical Cancer II

Cervical Cancer III

Cervical Cancer IV

44
Q

What is cervical cancer IA?

A

It is defined as malignancy confined to the cervix, which is only visible by microscopy and less than 7mm wide

45
Q

What is cervical cancer IB?

A

It is defined as malignancy confined to the cervix, which is clinically visible or greater than 7mm wide

46
Q

What is cervical cancer II?

A

It is defined as malignancy extending beyond the cervix, however not to the pelvic wall

47
Q

What is cervical cancer III?

A

It is defined as malignancy extending beyond the cervix and to the pelvic wall

48
Q

What is cervical cancer IV?

A

It is defined as malignancy which either extends beyond the pelvis or involves the bladder or rectum

49
Q

What is the management option of cervical intraepithelial neoplasia one?

A

There is routine observation conducted, however treatment is not offered

50
Q

What is the management option of cervical intraepithelial neoplasia two/three?

A

Large loop excision of the transformation zone (LLETZ)

51
Q

What is the management option of cervical cancer IA - in those who don’t wish to maintain fertility?

A

Hysterectomy ± lymph node clearance

52
Q

What is the management option of cervical cancer IA - in those who wish to maintain fertility?

A

Cone biopsies with negative margins

53
Q

What is the management option of cervical cancer IB1?

A

Radiotherapy with concurrent cisplatin chemotherapy

54
Q

What is the management option of cervical cancer IB2?

A

Radical hysterectomy with pelvic lymph node dissection

55
Q

What is the management option of cervical cancer II?

A

Radiotherapy with concurrent cisplatin chemotherapy

56
Q

What is the management option of cervical cancer III?

A

Radiotherapy with concurrent cisplatin chemotherapy

57
Q

What is the management option of cervical cancer IV?

A

Radiotherapy with concurrent cisplatin chemotherapy

58
Q

What HPV vaccination is currently administered?

A

9-valent vaccine Gardasil 9

59
Q

What nine human papilloma virus infections does the HPV vaccination provide protection against?

A

HPV 6

HPV 11

HPV 16

HPV 18

HPV 31

HPV 33

HPV 45

HPV 52

HPV 58

60
Q

Which three paitent groups recieve the HPV vaccine?

A

Girls & Boys, 11 – 14 Years Old

Men Who Have Sex With Men, Aged 15 – 42 Years Old

High Risk Individuals (Transgender, Sex Workers, HIV Patients)

Year Three - Reproductive System (52 decks)

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