Cervical Cancer Flashcards
What is cervical cancer?
It is defined as the proliferation of malignant cells in the cervical epithelium
What is the most common classification of cervical cancer?
Squamous cell carcinomas
What is the second most common classification of cervical cancer?
Adenocarcinoma
What is the pathophysiological cause of cervical cancer?
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
What is cervical intraepithelial neoplasia (CIN)?
It is is defined as a premalignant dysplasia of the cervical epithelium, usually at the squamocolumnar junction, driven by infection with human papillomavirus (HPV)
What nine risk factors are associated with cervical cancer?
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
What are the five other high risk human papilloma virus infections associated with cervical cancer?
HPV 31
HPV 35
HPV 45
HPV 52
HPV 58
What are the five clinical features of cervical cancer?
Pelvic Pain
Abnormal Vaginal Bleeding
Abnormal Vaginal Discharge
Dyspareunia
Cervical Mass
What five investigations are used to diagnose cervical cancer?
Cervical Cancer Screening
Blood Tests
Cervical Swabs
Cervical Colposcopy
Pelvic MRI Scans
How is cervical screening used to investigate cervical cancer?
It is used to detect pre-malignant changes, in order to prevent progression of cervical intraepithelial neoplasia into cervical cancer
Who is offerred cervical cancer screening? How often?
All women between 24 – 64 years old
Every five years
What are the three exceptions to the usual cervical cancer screening schedule?
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
How do we conduct cervical cancer screening?
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
What are the three tests conducted on cervical smear samples?
High Risk HPV PCR Testing
Cervical Cytology
Cervical Colposcopy
What is high risk HPV PCR testing?
It involves testing for viral DNA of human papilloma virus strains 16/18/33 within the cervical sample
What is the most appropriate step when hrHPV results are negative?
The patient is returned to the normal recall of the screening programme
What is the most appropriate step when hrHPV results are positive?
The cervical smear sample should be examined cytologically
What is cervical cytology?
It involves examination of the cervical cells under the microscope in order to detect cellular abnormalities indicative of human papilloma virus infection
What is the feature of human papilloma virus on cervical cytology?
Koilocytes
What are the four features of koliocytes on cervical cytology?
Nucleus Enlargement
Irregular Nuclear Membrane Contour
Hyperchromasia
Perinuclear Halo
What is hyperchromasia?
It is defined as darker staining of the nucleus
What is the most appropriate step when hrHPV results are positive with normal cervical cytology?
The cervical smear test should be repeated at 12 months
What is the most appropriate step when repeat smear at 12 months is now hrHPV negative?
The patient should return to the normal recall of the screening programme
What is the most appropriate step when repeat smear at 12 months is still hrHPV positive with normal cervical cytology ?
The cervical smear test should be repeated at 12 months
