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OBGYN > Cervical Cancer > Flashcards

Cervical Cancer Flashcards

1
Q

When is cervical cancer incidence at a peak?

A

younger women - peak in reproductive years

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2
Q

What type are 80% of cervical cancers?

A

Squamous cell carcinoma

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3
Q

What is the next most common type of cervical cancer?

A

Adenocarcinoma

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4
Q

What is the most common cause of cervical cancer?

A

Infection with human papilloma virus (HPV)

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5
Q

What cancers is HPV a/w/?

A
  • cervical cancer
  • anal
  • vulval
  • vaginal
  • penis
  • mouth & throat
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6
Q

Which of the over 100 strains of HPV are a/w/ cervical cancer?

A

16 & 18 (70% of cervical cancer)

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7
Q

How does HPV cause cancer?

A

P53 and pRb are tumour suppressor genes. They have a role in suppressing cancers from developing. HPV produces two proteins (E6 and E7) that inhibit these tumour suppressor genes. The E6 protein inhibits p53, and the E7 protein inhibits pRb. Therefore, HPV promotes the development of cancer by inhibiting tumour suppressor genes.

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8
Q

What are the signs factors for cervical cancer?

A

Increased risk of catching HPV:
* early sexual activity
* increased number of sexual partners
* not using condoms

Non-engagement with cervical screening

Other risk factors:
* smoking
* HIV (get yearly smears)
*. Combined contraceptive pill for more than 5 years
* increased number of full-term pregnancies
* family history
* exposure to diethylstilbestrol during fetal development (used to prevent miscarriages)

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9
Q

What are some of the presenting symptoms of cervical cancer?

A
  • abnormal vaginal bleeding (IMB, PCB, PMB)
  • vaginal discharge
  • pelvic pain
  • dyspareunia
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10
Q

What appearances may suggest cervical cancer?

A
  • ulceration
  • inflammation
  • bleeding
  • visible tumour
  • refer for urgent colposcopy
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11
Q

What grading system is used for the level of dysplasia (premalignant change) in the cells of the cervix?

A

cervical intraepithelial neoplasia (CIN)

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12
Q

When is CIN diagnosed?

A

At colposcopy NOT with cervical screening

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13
Q

What abnormality is found during smear results?

A

Dyskaryosis

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14
Q

What are the different grades of CIN?

A
  • CIN I = mild dysplasia, affecting 1/3 the thickness of epithelial layer, likely to return to normal w/o 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
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15
Q

What is CIN III aka?

A

Cervical carcinoma in situ

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16
Q

What way of transporting the cells of a smear test is used?

A

Liquid based cytology

17
Q

How is a smear test examined?

A

Sample initially tested for HPV

If negative cells not examined

18
Q

What is the routine timing of smear tests?

A
  • every 3 years aged 25-29
  • every 5 years aged 30-65
19
Q

What are the exceptions to the routine screening program?

A
  • Women with HIV are 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)
  • Pregnant women due a routine smear should wait until 12 weeks post-partum
20
Q

What are the potential cytology results of a smear test?

A
  • inadequate
  • normal
  • borderline changes
  • low-grade dyskaryosis
  • high-grade dyskaryosis (moderate)
  • high-grade dyskaryosis (severe
  • possible invasive squamous cell carcinoma
  • possible glandular neoplasia
21
Q

What infections may be identified on a smear test?

A
  • bacterial vaginosis
  • candidiasis
  • trichomoniasis
22
Q

How are cervical smear test results managed?

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

23
Q

What stains can help differentiate areas during colposcopy?

A
  • acetic acid
  • iodine solution
24
Q

What does acetic acid do during a colposcopy?

A
  • causes abnormal cells to appear white = acetowhite
  • cells with increased nuclear to cytoplasmic ratio such as CIN and cervical cancer cells
25
Q

What does Schiller’s iodine test involve?

A

Using iodine solution to stain the cells of the cervix
- iodine will stain healthy cells brown
- abnormal areas will not stain

26
Q

What two procedures can be done during colposcopy?

A
  • punch biopsy
  • LLETZ
27
Q

What is a Large Loop Excision of the Transformation Zone (LLETZ) (aka loop biopsy)?

A

Using a loop of wire with electrical current (diathermy) to remove abnormal epithelial tissue on the cervix
- cauterises the tissue and stops bleeding
- done with LA

28
Q

What are the risks/ negatives a/w/ LLETZ?

A
  • bleeding and abnormal discharge - several weeks
  • avoid tampon use or intercourse to reduce infections
  • depending on depth of procedure can increase risk of preterm labour
29
Q

What is a treatment for CIN and very early stage cervical cancer?

A

Cone biopsy

30
Q

What is involved in a cone biopsy?

A
  • general anaesthesia
  • surgeon removes cone shaped piece of cervix with scalpel
  • sample sent for histology
31
Q

What are the main risks of a cone biopsy?

A
  • pain
  • bleeding
  • infection
  • scar formation with stenosis of the cervix
  • increased risk of miscarriage and premature labour
32
Q

How is cervical cancer staged?

A

International Federation of Gynaecology and Obstetrics (FIGO) staging system is used to stage cervical cancer:

Stage 1: Confined to the cervix
Stage 2: Invades the uterus or upper 2/3 of the vagina
Stage 3: Invades the pelvic wall or lower 1/3 of the vagina
Stage 4: Invades the bladder, rectum or beyond the pelvis

33
Q

How is cervical cancer managed based on stage?

A

Cervical intraepithelial neoplasia and early-stage 1A: LLETZ or cone biopsy

Stage 1B – 2A: Radical hysterectomy and removal of local lymph nodes with chemotherapy and radiotherapy

Stage 2B – 4A: Chemotherapy and radiotherapy

Stage 4B: Management may involve a combination of surgery, radiotherapy, chemotherapy and palliative care

34
Q

What is the prognosis of cervical cancer?

A

5-year survival drops significantly with more advanced cervical cancer, from around 98% with stage 1A to around 15% with stage 4

35
Q

What operation can be used in advanced cervical cancer?

A

Pelvic exenteration - removing most or all of the pelvic organs including vagina, cervix, uterus, Fallopian tubes, ovaries, bladder and rectum
- huge operation, significantly impact QOL

36
Q

What new drug can be used in the treatment of metastatic or recurrent cervical cancer?

A

Bevacizumab (Avastin) = monoclonal antibody that may be used in combo with other chemos

37
Q

How does bevacizumab (avastin) work?

A

targets vascular endothelial growth factor A (VEGF-A), which is responsible for the development of new blood vessels. Therefore, it reduces the development of new blood vessels

38
Q

What strain of HPV causes genital warts?

A

6 & 11

39
Q

What is the HPV vaccine Gardasil protecting against?

A

6, 11, 16, 18

OBGYN (25 decks)

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