Cervical Cancer Flashcards
Types of cervical cancer
Squamous cell carcinoma
Adenocarcinoma
Condition strongly associated with HPV
HPV - human papilloma virus 16 and 18
Prevention of HPV
Children ages 12 - 13 are offered a HPV vaccination
Cervical screening
Every 3 years if aged 25 - 49
Every five years if aged 50 - 64
Smear test which identifies HPV
How is HPV transmitted
Sexually transmitted disease
Which cancers are associated with HPV
Cervical Anal Vulval Throat Vaginal Penile Mouth
How does HPV 16 and 18 increase the risk of cancer
HPV produces two proteins (E6 and E7) that inhibit these tumour suppressor genes.
E6 protein - inhibits p53
E7 protein - inhibits pRb
Risk factors for cervical cancer related to HPV
Increased risk of catching HPV:
- multiple sexual partners
- MSM
- early age of first intercourse
- no barrier protection
Risk factors for Cervical cancer
Smoking
HIV
COCP - use for more than five years
Increased number of full-term pregnancies - increased gravidity
Family history
Presentation of cervical cancer
Abnormal vaginal bleeding (intermenstrual, postcoital or post-menopausal bleeding)
Vaginal discharge
Pelvic pain
Dyspareunia (pain or discomfort with sex)
Investigations for cervical cancer
Bimanual and speculum examination
Cervical smear test
If smear is abnormal/speculum is abnormal:
- urgent cancer referral for colposcopy
Appearances that may be suggestive of cervical cancer
Ulceration
Inflammation
Bleeding
Visible tumour
Cervical intraepithelial neoplasia (CIN)
Degree of cervical dysplasia diagnosed at colposcopy
CIN I
Mild dysplasia
Affecting 1/3 the thickness of the epithelial layer
Likely to return to normal without treatment
CIN II
Moderate dysplasia
Affecting 2/3 the thickness of the epithelial layer
Likely to progress to cancer if untreated
CIN III
Severe dysplasia
Very likely to progress to cancer if untreated
Known as cervical carcinoma in situ
Cervical test HPV positive
Cells tested for dyskaryosis
HIV patients cervical screening
Screened annually
Notable exceptions for continuing cervical screening
Women with HIV - screened annually
Women over 65 may request a smear if they have not had one since aged 50
Women with previous CIN may require additional tests (e.g. test of cure after treatment)
Certain groups of immunocompromised women may have additional screening (e.g. women on dialysis, cytotoxic drugs or undergoing an organ transplant)
When should pregnant women continue the cervical smear test
Pregnant women due a routine smear should wait until 12 weeks post-partum
Cytology results
Inadequate Normal Borderline changes Low-grade dyskaryosis High-grade dyskaryosis (moderate) High-grade dyskaryosis (severe) Possible invasive squamous cell carcinoma Possible glandular neoplasia
What else can be reported on a smear test
Infections:
- bacterial vaginosis
- candidiasis
- trichomoniasis
Management of smear results
Inadequate sample – repeat the smear after at least three months
HPV negative – continue routine screening
HPV positive with normal cytology – repeat the HPV test after 12 months
HPV positive with abnormal cytology – refer for colposcopy
Colposcopy
Inserting a speculum and using a colposcope to magnify the cervix.
Acetic acid and iodine solution can be used to differentiate abnormal areas
Acetic acid
Acetowhite - causes abnormal cells to appear white
Occurs in cells with an increased nuclear to cytoplasmic ratio (more nuclear material), such as CIN and cervical cancer cells
Iodine test
Iodine will stain healthy cells a brown colour.
Abnormal areas will not stain.
How to get a cervical biopsy
Punch biopsy or large loop excision of the transformational zone during colposcopy
Large Loop Excision of the Transformation Zone (LLETZ)
Local anaesthetic
Loop of wire with diathermy
Complications of LLETZ
Bleeding
Abnormal discharge
If deep - may increase the risk of preterm labour
Advice for LLETZ
Intercourse and tampon use should be avoided after the procedure to reduce the risk of infection
Cone Biopsy
Treatment for CIN and very early stage cervical cancer
General anaesthetic
Surgeon removes a cone-shaped piece of the cervix using a scalpel.
Risks of a cone biopsy
Pain
Bleeding
Infection
Scar formation with stenosis of the cervix
Increased risk of miscarriage and premature labour
Management of cervical cancer
CIN and early-stage 1A: LLETZ or cone biopsy
Radical hysterectomy and removal of local lymph nodes with chemotherapy and radiotherapy
Pelvic exenteration
Used in advance cervical cancer
Removing most or all of the pelvic organs, including the vagina, cervix, uterus, fallopian tubes, ovaries, bladder and rectum
HPV vaccine
Gardasil
Protects against strains 6, 11, 16 and 18:
Strains 6 and 11 cause genital warts
Strains 16 and 18 cause cervical cancer
