Cervical Cancer Flashcards
Risk factors for cervical cancer
HPV - 16 & !8
Smoking
Cervical cancer screening pathway age and normal follow up if everything is normal.
25-64
25-49 = every three years
50-64 = every five years
What is tested for in the initial cervical cancer screen?
High risk HPV
If hrHPV is positive, what do you do next?
Send for cytology screen - check of cells are dysplastic at all.
If a pt is hrHPV +ve, cytology negative, what do we do?
Rescreen in a year, then if again the same result, rescreen again in a year
If a pt is hrHPV +ve, cytology negative, and then comes back a year later is again hrHPV +ve but cytology negative, what do we do? What do we do if this result comes back the same?
Rescan in 12 months. If 3x same result, then send for colposcopy
When would you send for colposcopy
If hrHPV and cytology come back positive, or if hrHPV comes back positive but cytology negative and stays this way for another 24 months.
Describe the anatomy of the cervix, types of cells etc.
The endocervix contains cuboidal COLUMNAR epithelium. The ectocervix contains squamous epithelium.
There are reserve cells which sit under the cuboidal COLUMNAR cells of the endocervix. These can differentiate to become basal cells of the squamous epithelium, or cuboidal cells of the endocervix.
The transformational zone (TZ) is the squamo-columnar junction where squamous cells become columnar cells.
What can affect the transformation zone? What is this condition called?
It is normal for the TZ to change according to increasing levels of oestrogen e.g. COCP, pregnancy. This can result in cervical ectropion. Symptoms include bleeding after sex and vaginal discharge.
Symptoms of cervical cancer
Post coital bleeding - PCB
PMB
IMB
Thick smelly discharge
Deep dyspareunia
How does HPV 16 lead to cancer?
HPV 16 produces an E6 protein which inhibits the tumour suppressor gene p53
How does HPV 18 lead to cancer?
HPV 18 produces an E7 protein which inhibits the tumour suppressor gene RB
What other types of cancers do HPV 16 and 18 cause?
Head and neck, anal and genital cancers
What is colposcopy? What happens?
It is a special microscope to visualise the cervix. Sometimes, acetic acid is applied to visualise abnormal areas with proteins which show up white.
What happens after colposcopy?
LLETZ - large loop excision of the transformation zone
or Biopsy
What are the stages of cervical cancerous changes?
CIN1 - 1/3 of the cells are cancerous
CIN 2 - 2/3
CIN 3 - 3/3 cancerous
2+ is bad
If someone has had a hysterectomy, what do you do?
Vault smear, then remove from the programme
What aftercare would you recommend for someone undergoing LLETZ?
4 weeks of no sex
RISKS: bleeding likely 3-5 days after, infection, failed procedure,
If LLETZ fails, what other option is there? When might this scenario occur?
Cone biopsy - when the CIN is deeper inside
What are the risks of a cone biopsy?
Increased risk of preterm labour
What are the three colposcopy examination outcomes if the examination is adequate?
Adequate -> colposcopy confirms CIN 1+, or biopsy confirms CIN1+ -> manage pt for CIN.
Adequate -> but CIN not confirmed on colposcopy or biopsy, then check the grading of the cytology.
- If low grade, recall in 36 months.
If high grade -> MDT discussion within 2 months.
What are the two colposcopy examination outcomes if the examination is inadequate?
Check the cytology - if low grade, repeat within 12 months (since colposcopy hasn’t necessarily disproved it). Consider LLETZ/what the patient wants.
If high grade, or borderline, do LLETZ.
If CIN 1 shown on biopsy or colposcopy, what do you think about next? What do you do?
Think about hrHPV.
If hrHPV negative, recall in 36 months.
If hrHPV positive, arrange to do a cytology screen too. If abnormal, do further colposcopy.
If not abnormal, call back in 12 months. If hrHPV or cytology negative at that point, recall in 3 years, if not, refer for colposcopy again.
If a pt has been treated for CIN2+ or CGIN, when do you recall?
In 6 months.
If a pt recalled after 6 months has been treated for CGIN, what do you do?
If hrHPV -ve, recall in 12m, then repeat hrHPV screen. If negative, recall in 36 months.
If hrHPV positive a second time round, refer for colp; if colp normal, recall in 12 months.
If hrHPV+ve, refer for colposcopy.
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