Cervical cancer Flashcards
What is the majority of cervical cancers
80% are squamous cell carcinoma
Next most common is adenocarcinoma
Rare - small cell cancer
What is cervical cancer strongly ass with
HPV
What cancers is HPV ass with?
Anal
Vulval
Vaginal
Penis
Mouth
Throat
What types of HPV are ass with 70% of cervical cancers
16+18
What types of HPV are ass with 70% of cervical cancers
16+18
How does HPV cause cervical cancer
HPV -> two proteins E6 +E7 that inhibit p53 +pRb which are tumour supressor genes
Risk faactors for cervical cancer
Increased risk of catching HPV
Later detection of precancerous and cancerous changes (non-engagement with screening)
Other risk facotrs
Non engagement with cervical screening
What increases the risk of catching HPV
Early sexual activity
Increased number of sexual partners
Sexual partners who’ve had more partners
Not using condoms
Other risk factors for cervical cancers
Smoking
HIV
COCP > 5 years
FH
Increased no. full term pregnancies
Exposure to diethylstillbestrol during foetal development - used to prevent miscarriages before 1971
What are patients with HIV offered
Yearly smear tests
What to ask about in a history concerened about cervical cancer
Attendance to smears
Number sexual partners
FH
Smoking
Presentation of cervical cancer
Abnormal vaginal bleeding (intermenstrual, postcoital or post-menopausal bleeding)
Vaginal discharge
Pelvic pain
Dyspareunia
What appearance are abnormal on speculum
Ulceration
Inflammation
Bleeding
Visibile tumour
What appearance are abnormal on speculum
Ulceration
Inflammation
Bleeding
Visibile tumour
What do if abnormal appearcance of cervic
urgent cancer referral for colposcopy
What is the grading system for cervical cancer
cervical intraepithelial neoplasia
How is CIN diagnosed and hwat does it measure
Colposcopy
Dysplasia - premalignant change
What is CIN I grade
mild dysplasia, affecting 1/3 the thickness of the epithelial layer, likely to return to normal without treatment
What is CIN II grade
moderate dysplasia, affecting 2/3 the thickness of the epithelial layer, likely to progress to cancer if untreated
What is CIN III grade
severe dysplasia, very likely to progress to cancer if untreated
Or cervical carcinoma in situ
What is dyskaryosis found in
Smear results
Its abnormal cytologic changes of squamous epithelial cells characterized by hyperchromatic nuclei and/or irregular nuclear chromatin
WHen are cells from smear tests examined
If HPV positive
If HPV negative considered negative smaple and not examined
When is cervical screening offered to women
Every 3 years aged 25-49
Every 5 years aged 50-64
Exceptions to the cervical screening programme
HIV - annual
>65 may request if not had one since 50
Women w prev CIN may require additional tests
Immunocompromised women additional screening (dialysism cytotoxic drugs, organ transplant)
Pregnant women due routine smear wait 12 weeks post partum
Cytology results levels
- Inadequate
- Normal
- Borderline changes
- Low-grade dyskaryosis
- High-grade dyskaryosis (moderate)
- High-grade dyskaryosis (severe)
- Possible invasive squamous cell carcinoma
- Possible glandular neoplasia
What infections may be identified and reported on a smear
BV
Candidiasis
Trichomoniasis
What orgnaisms are often discovered in women with a coil? management?
Actinomyces-like organisms
no treatment unless symptomatic
If symptomatic remove the IUD (pelvic pain or abnormal bleeding)
PHE guideleines on management of smear results
- 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
What is a colposcopy
Insert speculum and using colposcope to magnify cervix to view epithelial lining of cervix to be examined in detail. Acetic acid and iodine solution stains used to differentiate abnormal areas
How do abnormal cells appear on acetic acid stain
white - acetowhite
In cells with increased nuclear to cytoplasmic ratio (more nuclear material)
eg cervical intraepithelial neoplasia
Cervical cancer cells
What will show with abnormal cells and iodine solution
Iodine solution stains healthy cells brwon - abnormal areas wont stain
What can be performed during colposcopy to get tissue sample
Punch biopsy or large loop excision of transformational zone
What is a large loop excision of transformtion zone
loop of wire w electrical current - diathermy - to remove abnormal epithelial tissues on cervix
Cauterises to stop bleeding
What occurs after LLETZ
Bleeding
Abnormal discharge
Severeal weeks
Intercourse and tampon avoideed after procedure to reduce infection risk
Depth of tissue removed - deeper may mean risk of preterm labour
What is a cone biopsy treatment for
Cervical intraepithelial neoplasia and early stage cervical cancer
Surgeon removes cone shaped piece cervic with scalpol
Risks of cone biopsy
Pain
Bleeding
Infection
Scar formation with stenosis of cervix
Increased risk miscarraige and premature labour
Staging for cervical cancer
FIGO - 4 stages
Stage 1 cervical cancer
Confined to cervix
Stage 2 cervical cancer
Invades uterus or upper 2/3 vagina
Stage 3 cervical cancer
Invades pelvic wall or lower 1/3 vagina
Stage 4 cervical cancer
Invades bladder, rectum or beyond pelvis
What stage cervical cancer are the LLETZ or cone biopsy used to treat
Cervical intraepithelial neoplasia and early stage IA
What is the treatment for stage IB-2A
Radical hysterectomy and removal of local lymph nodes with chemo and radiotherapy
Stages 2B-4A cervical cancer management
Chemotherapy and radiotherapy
Stage 4B cervical cancer maangement
Combination of surgery, radiotherapy, chemotherapy and palliative care
Survival rate of cervical cancer
5 year survival
98% stage IA
15% stage 4
What is pelvic exenteration
Operation in advanced cervical cancer
Removing most or all of pelvic organs incl vagina, cervix, uterus, fallopian tubes, ovaries, bladder and rectum
Vast operation with significant implications on quality of life
What is bevacizumab (avastin)
Monoclonal antibody used in combination with other chemotherapies in treatment metastatic or recurrent cervical
What does bevacizumab do
Target VEGF-A - vascular endothelial growth factor A, decreases levels therefore reduces development of new blood vessels
Treatment for metastatic or recurrant cervical cancer
Bevacuzumab (avastin) monoclonal antibody
What does the HPV vaccine protect against and why is it given at 12
Before become sezually active to stop HPV trasnmission
Gardasil - protects against 6,11,16 and 18
What do HPV strains 6 and 11 cause
genital warts
