Cervical Cancer Flashcards
What constitutes the lower 1/3 of the uterine body?
Cervix
How many parts does the cervix have?
2 parts
- Endocervix with tall mucus secreting epithelium and
- Ectocervix with non-keratinized stratified squamous epithelium
What does CIN stand for?
Cervical intraepithelial neoplasia
What is CIN?
The pre-invasive stage of cervical cancer where there is dysplasia, it’s asymptomatic and detectable by cervical screening
Where does the squamo-columnar junction present in pregnancy/from puberty onwards?
Vaginal surface of the external os
-This is also the area where squamous metaplasia occurs
Precursor of cervical squamous carcinoma?
CIN
Cervical intraepithelial neoplasia
What causes genital warts?
Low risk HPV strains 6+ 11
What type of cells indicate HPV infection?
Koilocytes
What are koilocytes?
Cells with a wrinkled pyknotic nucleus and perinuclear clearing
What is pyknosis?
The irreversible condensation of chromatin in the nucleus of a cell
Main strains implicated in cervical cancer?
HPV 16 and 18
Precursor to adenocarcinoma?
CGIN
Most cases of cervical cancer are caused by genetics. True or False?
FALSE
Caused by high risk HPV infection
How is HPV transmitted?
Via close skin to skin contact such as genital to genital contact and anal, vaginal and oral sex
Can HPV cause other cancers aside from cervical?
Yes.
Vulval, vaginal, anal and oropharyngeal cancers
Where do most squamous carcinomas arise?
Squamo-columnar junction
Where does squamous carcinoma initially spread to?
Uterine body Vagina Bladder Ureters Rectum
How does lymphatic spread usually occur in squamous carcinoma?
Can spread early via the external, internal and common iliac nodes as well as aortic nodes
When does haematogenous spread occur?
Late in squamous carcinoma
-Spreads to liver, lungs ad bones
What is CGIN?
Preinvasive of adenocarcinoma and is more difficult to diagnose on a smear
What percentage of carcinoma is adenocarcinoma? and where does it commonly arise?
10%
-Most arise in endocervical canal
What does cervical screening look for?
For CIN before it becomes clear
Who should be screened for cervical screening?
Those with a cervix
Every 5 years
Age 25-65
Process of cervical screening?
1) Smear is tested for HPV, if negative nothing further is done
2) If positive the cytology is looked at
3) If smear is negative: recall in 5 years
Cervical screening:
-HPV +ve, cytology +ve, low grade:
Seen for colposcopy within 8 weeks
Cervical screening:
HPV: +ve, +ve cytology, high grade
Seen for colposcopy within 4 weeks
Cervical screening:
HPV positive, glandular abnormality or suspicion of invasion?
Seen within 2 weeks
What does colposcopy do?
This allows the cervix to be examined in more detail through use of speculum and microscope
-Squamocolumnar junction must be visualized
What happens when acetic acid is applied in colposcopy to a cancer?
Epithelium appears white in colour because abnormal epithelium contains more protein and less glycogen than normal epithelium
What happens after acetic acid turns epithelium white?
Punch biopsy
- To identify CIN
Treatment of CIN-1?
Conservative management for 2 years
Treatment of CIN 2 or 3?
Excision or ablation
Presentation of cervical cancer?
- Often asymptomatic in early stages
- Post coital bleeding
- Foul smelling discharge which in thin, watery and sometimes blood stained
- Intermenstrual bleeding
- Pelvic pain
- Menorrhagia
Advanced disease;
-Backache, leg pain, haematuria, wt loss, anaemia, changes in bowel habit
Investigations of cervical cancer?
- Colposcopy
- Biopsy of tumour
- MRI and PET for assessment of spread
Management of cervical cancer?
- Local excision can be done for 1A lesions
- Hysterectomy can be done with stage IB-IIB and may also offer radiotherapy (stage II involvement of adjacent organs)
- Stage IIB-IV is usually treated with chemoradiation and platinum based chemo (III has involvement of pelvic wall and IV has distant mets or bladder/rectum involvement)
- Most recurrences of cervical cancers are only suitable for palliative acre
What does stage II mean?
Involvement of adjacent organs
Stage III means?
Involvement of pelvic wall
Stage IV?
Distant mets or bladder/rectum involvement
HPV vaccination is given to who?
Boys and girls
Age 12-13 as 2 doses 6 months apart
What is the current vaccine?
Quadrivalent for types 16, 18, 6 and 11 (2 high risk types and 2 types which cause genital warts)
How muc protection does HOV vaccination offer?
70% protection against cervical cancer
