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#Phase 2.2: Obs n Gynae > Cervical Cancer > Flashcards

Cervical Cancer Flashcards

1
Q

What age group does Cervical Cancer tend to affect more?

A

Young women (in reproductive years)

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2
Q

What is the most common type of Cervical Cancer?

A

Squamous cell carcinoma (80%)

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3
Q

What is the second most common type of Cervical Cancer?

A

Adenocarcinoma

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4
Q

What is the most common cause of Cervical Cancer?

A

HPV (STI)

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5
Q

What is the pathophysiology of HPV causing Cervical Cancer? (4 points)

A
  1. HPV produces 2 proteins: E6 + E7
  2. E6 inhibits p53 (tumour suppressor gene)
  3. E7 inhibits pRb (tumour suppressor gene)
  4. Therefore: HPV promotes cancer dev by inhibiting tumour suppressor genes
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6
Q

What strains of HPV are responsible for 70% of Cervical Cancers? (2 things)

A
  1. Type 16
  2. Type 18
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7
Q

What are the RF for Cervical Cancer? (6 things)

A
  1. HPV (main)
  2. Smoking
  3. HIV
  4. COCP use for 5+ years
  5. High number of full-term pregnancies
  6. FHx
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8
Q

What are the RF for catching HPV? (4 things)

A
  1. Early sexual activity
  2. High no. of partners
  3. Partners who have had more partners
  4. Not using condoms
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9
Q

What are the CF of Cervical Cancer? (5 things)

A
  1. Asymptomatic (detected @ routine smear)
  2. Pelvic pain
  3. Dyspareunia (pain @ intercourse)
  4. Abn vaginal bleeding (intermenstrual / postcoital / post-menopausal)
  5. Vaginal discharge
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10
Q

Why is it hard to diagnose Cervical Cancer from symptoms alone?

A

Symptoms are non-specific, and usually NOT caused by Cervical Cancer

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11
Q

What investigation should be done for sus Cervical Cancer?

A

Speculum examination

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12
Q

What can be done during a Speculum examination in sus Cervical Cancer and why?

A

Swabs to exclude infection

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13
Q

What abn appearances of the cervix warrant an Urgent Cancer Referral for Colposcopy? (4 things)

A
  1. Ulceration
  2. Inflamm
  3. Bleeding
  4. Visible tumour
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14
Q

What are you aiming to diagnose / exclude @ Colposcopy?

A

CIN aka Cervical Intraepithelial Neoplasia

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15
Q

What is CIN?

A

A grading system for the level of dysplasia (aka premalignant changes) in cervical cells

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16
Q

What are the CIN grades?

A
  • CIN I = mild dysplasia
  • CIN II = moderate dysplasia
  • CIN III = severe dysplasia
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17
Q

What does CIN I (aka mild dysplasia) mean? (2 things)

A
  1. Dysplasia affecting 1/3 thickness of epithelial layer
  2. Likely to return normal w/o tx
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18
Q

What does CIN II (aka moderate dysplasia) mean? (2 things)

A
  1. Dysplasia affecting 2/3 thickness of epithelial layer
  2. Likely to progress to cancer if left untreated
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19
Q

What does CIN III (aka severe dysplasia) mean?

A

Very likely to progress to cancer if untreated

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20
Q

What are the aims of the screening programme for Cervical Cancer?

A

Pick up precancerous changes in cervix epithelium

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21
Q

How often are the different age groups of women screened for Cervical Cancer?

A
  1. Age 25-49: every 3 years
  2. Age 50-64: every 5 years
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22
Q

What are the exceptions to the Cervical Cancer screening program? (5 things)

A
  1. HIV pt: Screen anually
  2. 65+ yrs: Can request smear if not had one since 50 yrs old
  3. Hx of CIN: May require additional tests (e.g to test for cure after tx)
  4. Immunocompromised pt: Additional screening
  5. Pregnant: Must wait 12 wks post-partum
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23
Q

What does the screening for Cervical Cancer involve?

A

Smear test

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24
Q

How is a smear test done for Cervical Cancer screening?

A
  1. Speculum examination + collect cervical cells w small brush
  2. Cells sent to lab
25
Q

Who can do the smear test for Cervical Cancer screening?

A

Practice nurse

26
Q

What are smear samples tested for before the cells are examined?

A

High-risk HPV

27
Q

What happens next depending on the result of the High-risk HPV testing on the smear sample?

A
  • HPV negative = cells NOT examined –> continue routine screening
  • HPV positive = cells examined (cytology)
28
Q

What happens next depending on the cytology of the HPV positive smear?

A
  • Normal cytology: repeat HPV test after 12 months
  • Abn cytology: refer for colposcopy
29
Q

How are abn areas of cervix differentiated in Colposcopy?

A

Using stains

30
Q

What are the different stains used in Colposcopy? (2 things)

A
  1. Acetic acid
  2. Iodine
31
Q

What will you see in Colposcopy with Acetic Acid?

A

Abn cells = white (called acetowhite)

32
Q

What will you see in Colposcopy with Iodine?

A
  1. Healthy cells = brown
  2. (Abn areas won’t stain)
33
Q

How can you get a tissue sample during Colposcopy? (2 things)

A
  1. Punch biopsy
  2. Large Loop Excision of the Transformational Zone (LLETZ)
34
Q

What anaesthetic can LLETZ done under?

A

Local

35
Q

What does LLETZ involve?

A

Using loop of wire w electrical current (diathermy) to remove abn epithelial cervix tissue

36
Q

What are the side fx of LLETZ? (3 things)

A
  1. Bleeding
  2. Abn discharge
  3. Increased risk of Preterm labour
37
Q

What should be avoided after LLETZ and why? (2 things)

A
  1. Intercourse
  2. Tampon use

(to reduce infection risk)

38
Q

What staging system is used for Cervical Cancer?

A

FIGO

(International Federation of Gynaecology and Obstetrics)

39
Q

What are the FIGO stages of Cervical Cancer?

A
  • Stage 1: Confined to cervix
  • Stage 2: Invades uterus / upper 2/3 of vagina
  • Stage 3: Invades pelvic wall / lower 1/3 of vagina
  • Stage 4: Invades bladder / rectum / beyond pelvis
40
Q

What are the Mx options for CIN / Early stage 1A Cervical Cancer? (2 things)

A
  1. LLETZ
  2. Cone biopsy
41
Q

What is Cone biopsy?

A

Tx for CIN / Early Stage 1A Cervical Cancer

42
Q

What anaesthetic is Cone biopsy done under?

A

General

43
Q

What does Cone biopsy involve? (2 steps)

A
  1. Cone shaped piece of cervix removed w Scalpel
  2. Sample sent for histology to assess for malignancy
44
Q

What are the side fx of Cone biopsy? (5 things)

A
  1. Pain
  2. Bleeding
  3. Inf
  4. Scar formation w Stenosis of cervix
  5. Increased risk of Miscarriage / Premature labour
45
Q

What are the Mx options for Stage 1B / 2A Cervical Cancer? (4 things)

A
  1. Radical hysterectomy
  2. Removal of local lymph nodes
  3. Chemo
  4. Radio
46
Q

What are the Mx options for 2B - 4A Cervical Cancer? (2 things)

A
  1. Chemo
  2. Radio
47
Q

What are the Mx options for 4B Cervical Cancer? (4 things)

A
  1. Surgery
  2. Radio
  3. Chemo
  4. Palliative care
48
Q

What is the Surgical Mx option for 4B Cervical Cancer?

A

Pelvic extenteration

49
Q

What is removed in Pelvic exenteration? (7 things)

A

Most / All pelvic organs:

  1. Vagina
  2. Cervix
  3. Uterus
  4. Fallopian tubes
  5. Ovaries
  6. Bladder
  7. Rectum
50
Q

Why are early detection and screening programmes for Cervical Cancer so important? (2 points)

A
  • 5 year survival of Stage 1A: 98%
  • 5 year survival of Stage 4: 15%
51
Q

What chemo is used for Cervical Cancer?

A

Bevacizumab (Avastin)

52
Q

What is Bevacizumab (Avastin)?

A

Monoclonal antibody

53
Q

What types of Cervical Cancer is Bevacizumab (Avastin) used for? (2 things)

A
  1. Metastatic
  2. Recurrent
54
Q

What does Bevacizumab (Avastin) target?

A

Vascular Endothelial Growth Factor A (VEGF-A) –> responsible for new blood vessel dev

(so dis tx stops dis)

55
Q

What vaccine is used to protect against HPV?

A

Gardasil

56
Q

When should Gardasil vaccine be given to people?

A

When they’re kids before they’re sexually active

57
Q

What strains of HPV does Gardasil protect against? (4 things)

A

6, 11, 16, 18

58
Q

What are the HPV strains 6, 11, 16 and 18 responsible for? (2 things)

A
  1. 6 + 11 = Genital warts
  2. 16 + 18 = Cervical Cancer

#Phase 2.2: Obs n Gynae (27 decks)

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