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Year 4 Oncology > Cervical Cancer > Flashcards

Cervical Cancer Flashcards

1
Q

Types of cervical cancer

A

Squamous cell carcinoma

Adenocarcinoma

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2
Q

Condition strongly associated with HPV

A

HPV - human papilloma virus 16 and 18

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3
Q

Prevention of HPV

A

Children ages 12 - 13 are offered a HPV vaccination

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4
Q

Cervical screening

A

Every 3 years if aged 25 - 49

Every five years if aged 50 - 64

Smear test which identifies HPV

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5
Q

How is HPV transmitted

A

Sexually transmitted disease

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6
Q

Which cancers are associated with HPV

A 
Cervical 
Anal 
Vulval 
Throat 
Vaginal 
Penile 
Mouth
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7
Q

How does HPV 16 and 18 increase the risk of cancer

A

HPV produces two proteins (E6 and E7) that inhibit these tumour suppressor genes.

E6 protein - inhibits p53
E7 protein - inhibits pRb

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8
Q

Risk factors for cervical cancer related to HPV

A

Increased risk of catching HPV:

  • multiple sexual partners
  • MSM
  • early age of first intercourse
  • no barrier protection
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9
Q

Risk factors for Cervical cancer

A

Smoking

HIV

COCP - use for more than five years

Increased number of full-term pregnancies - increased gravidity

Family history

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10
Q

Presentation of cervical cancer

A

Abnormal vaginal bleeding (intermenstrual, postcoital or post-menopausal bleeding)

Vaginal discharge

Pelvic pain

Dyspareunia (pain or discomfort with sex)

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11
Q

Investigations for cervical cancer

A

Bimanual and speculum examination
Cervical smear test

If smear is abnormal/speculum is abnormal:
- urgent cancer referral for colposcopy

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12
Q

Appearances that may be suggestive of cervical cancer

A

Ulceration
Inflammation
Bleeding
Visible tumour

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13
Q

Cervical intraepithelial neoplasia (CIN)

A

Degree of cervical dysplasia diagnosed at colposcopy

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14
Q

CIN I

A

Mild dysplasia

Affecting 1/3 the thickness of the epithelial layer

Likely to return to normal without treatment

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15
Q

CIN II

A

Moderate dysplasia

Affecting 2/3 the thickness of the epithelial layer

Likely to progress to cancer if untreated

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16
Q

CIN III

A

Severe dysplasia

Very likely to progress to cancer if untreated

Known as cervical carcinoma in situ

17
Q

Cervical test HPV positive

A

Cells tested for dyskaryosis

18
Q

HIV patients cervical screening

A

Screened annually

19
Q

Notable exceptions for continuing cervical screening

A

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)

20
Q

When should pregnant women continue the cervical smear test

A

Pregnant women due a routine smear should wait until 12 weeks post-partum

21
Q

Cytology results

A 
Inadequate
Normal
Borderline changes
Low-grade dyskaryosis
High-grade dyskaryosis (moderate)
High-grade dyskaryosis (severe)
Possible invasive squamous cell carcinoma
Possible glandular neoplasia
22
Q

What else can be reported on a smear test

A

Infections:

  • bacterial vaginosis
  • candidiasis
  • trichomoniasis
23
Q

Management of smear results

A

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

24
Q

Colposcopy

A

Inserting a speculum and using a colposcope to magnify the cervix.

Acetic acid and iodine solution can be used to differentiate abnormal areas

25
Q

Acetic acid

A

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

26
Q

Iodine test

A

Iodine will stain healthy cells a brown colour.

Abnormal areas will not stain.

27
Q

How to get a cervical biopsy

A

Punch biopsy or large loop excision of the transformational zone during colposcopy

28
Q

Large Loop Excision of the Transformation Zone (LLETZ)

A

Local anaesthetic

Loop of wire with diathermy

29
Q

Complications of LLETZ

A

Bleeding

Abnormal discharge

If deep - may increase the risk of preterm labour

30
Q

Advice for LLETZ

A

Intercourse and tampon use should be avoided after the procedure to reduce the risk of infection

31
Q

Cone Biopsy

A

Treatment for CIN and very early stage cervical cancer

General anaesthetic

Surgeon removes a cone-shaped piece of the cervix using a scalpel.

32
Q

Risks of a cone biopsy

A

Pain

Bleeding

Infection

Scar formation with stenosis of the cervix

Increased risk of miscarriage and premature labour

33
Q

Management of cervical cancer

A

CIN and early-stage 1A: LLETZ or cone biopsy

Radical hysterectomy and removal of local lymph nodes with chemotherapy and radiotherapy

34
Q

Pelvic exenteration

A

Used in advance cervical cancer

Removing most or all of the pelvic organs, including the vagina, cervix, uterus, fallopian tubes, ovaries, bladder and rectum

35
Q

HPV vaccine

A

Gardasil

Protects against strains 6, 11, 16 and 18:

Strains 6 and 11 cause genital warts
Strains 16 and 18 cause cervical cancer

Year 4 Oncology (21 decks)

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