Cervical cancer Flashcards
What is the distribution of incidence for cervical cancer?
Bimodal: 25-29 and >80 peak
List two risk factors for cervical cancer
HPV smoking COCP use multiple sexual partners immunosuppression
Which HPV subtypes are implicated in cervical cancer?
16 and 18
When do vaccinations take place for HPV?
11-13 girls (boys as well for herd immunity)
Which vaccination is given and against which HPV strains is it effective?
GARDISAL
HPV 6,11,16,18
What is the minimum protection?
10 years
What is the screening age and rate of screening?
25-65y
25-49 every 3 years
>50 every 5 years
What are the two cell types in the cervix?
endocervix- columnar epithelium
ectocervix- squamous epithelium
Where does cervical cancer occur?
transitional zone, between columnar and squamous epithelium. This is a physiological site of metaplasia, however HPV interferes with this process
If an abnormal cervix is observed during smear test, what should be done?
smear is inappropriate- require biopsy
Name two modalities of biopsy for CC?
punch
LLETZ- large loop excision of transformation zone
Name two indications for colposcopy referral
abnormal screening smear
suspcious symptoms/abnormal cervix
How are pathological changes viewed with the colposcopy?
application of acetic acid which highlight mosaisicsm, abnormal vessels, and acetowhite appearance
What are the types of CIN?
CIN 1= low grade
CIN 2 and CIN3= high grade
Which CIN types require treatment?
CIN2 and 3
not CIN1- monitor
What are the treatment options for high grade CIN?
destructive= cold coagulation, cryotherapy
excisional= LLETZ, laser, cold knife cone
If patient displays high grade CIN, what is their follow up after treatment?
6 months with high risk HPV test
What is the most common type of cervical cancer?
squamous cell carcinoma
List two types of cervical cancer?
squamous cell carcinoma adenocarcinoma adenosquamous carcinoma endometriod serous
Name two typical presentations of cervical cancer
unschedueled vaginal bleeding
offensive vaginal discharge
supraclavicular lymph node
obstructive renal failure
Why are U+Es particularly important when investigating cervical cancer?
due to anatomical compression of ureters from cervical mass
List three aspects of CC diagnosis
Lymph node exam- supraclavicular abdo exam speculum bimanual PR colposcopy
Why is a PR conducted?
to assess parametrium
List two imaging modalities for CC
MRI>CT
PET-CT for staging
What is the parametrium?
band of fibrous tissue that separates the supravaginal portion of the cervix from the bladder.
Name one poor prognostic factor
lymph node involvement
lymphovascular space
parametrial extension
What is the management of CC?
surgery- simple vs radical
chemo
radiotherapy
Which chemo agent is used?
cisplatin
Name two fertility conserving surgeries?
LLETZ
Trachelectomy= cervix, upper vagina and parametrium removal
Laparscopic lymphadenectomy pelvic lymph nodes
Does radical hysterectomy via open surgery or laparoscopy have the better outcome?
open surgery
A 60 year old female has never had a cervical smear test but has only had one sexual partner her whole life. Are you worried about cervical cancer?
very unlikely…
