Cervical Cancer Flashcards
What type of tumour are most cervical cancers?
Squamous cell carcinoma
What is the second most common type of cervical cancer?
Adenocarinoma
What virus is heavily associated with cervical cancer?
Human papillomavirus
What strains of HPV is cervical cancer primarily associated with?
HPV 16, 18 (and 33)
How does HPV cause cervical cancer?
HPV produces the E6 and E7 oncogenes
E6 oncogene inhibits the p53 suppressor gene
E7 oncogene inhibits the pRB supppressor gene
What are the risk factors for cervical cancer?
HPV types 16, 18 and 33
Smoking
HIV
Early first intercourse
Many sexual partners
High parity
Long term combined contraceptive pill use
What is the presentation of cervical cancer?
Abnormal vaginal bleeding
Vaginal discharge
Pelvic pain
Dyspareunia
What is the first line investigation of cervical cancer?
Vaginal examination and urgent colposcopy
What is colposcopy?
Colposcopy is an imaging technique using a colposcope, where the cervix is magnified which allows the epithelial lining to be examined
What other investigations are useful in the diagnosis of cervical cancer?
Biopsy
HPV testing
FBC
CT chest/abdo/pelvis
How is epithelial dysplasia graded?
CIN (cervical intraepithelial neoplasia) 1 - mild dysplasia, affecting 1/3 of the thickness of the epithelium
CIN 2 - moderate dysplasia, affecting 2/3 of the thickness of the epithelium
CIN 3 - severe dysplasia - likely to turn into cancer if untreated
At what age is cervical screening offered?
25-64
How often are women screened for cervical cancer?
Every 3 years for those 25-49
Every 5 years for those 50-64
What is dyskaryosis?
Abnormal cervical cells detected on a cervical smear
How are cervical smear results interpreted?
HPV negative - return to normal recall
HPV positive and normal cytology - repeat HPV test in 12 months
HPV positive and abnormal cytology - refer for colposcopy
What is the treatment of cervical intraepithelial neoplasia to prevent cancer?
LLETX procedure (large loop excision of the transformation zone)
What is a LLETZ procedure?
A loop of wire with electrical current removes abnormal cervical tissue. This can be performed under local anaesthetic during colposcopy
What is the staging of 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 3 - Invades the bladder, rectum or beyond the pelvis
What is the different between stage 1A and 1B cervical cancer?
Stage 1A is only visible by microscopy and is less than 7mm large, whereas stage 1B is clinically visible, or more than 7mm
What is the treatment of cervical cancer?
CIN or stage 1A - LLETZ procedure or cone biopsy
Stage 1B- 2A - radical hysterectomy and removal or local lymph nodes
Stage 2B-4A - Chemotherapy and radiotherapy
Stage 4B - combination of chemo, radiotherapy and surgery
What is a cone biopsy?
A procedure that involves moving a small, cone shaped piece of the cervix
To who and when is the HPV vaccine given to?
The HPV vaccine is given to boys and girls aged 12 and 13 (before they become sexually active)
When should a patient be recalled if they have a +ve HPV screen, and is -ve after a 12 month follow up?
Return to normal recall
When should a patient be recalled if they have two +HPV screens, but cytology is normal for both?
Recall after 12 months
What should be done if a patient have +HPV screen with normal cytology after two follow up 12 month screens?
Refer for colposcopy
When should a patient who has had treatment for CIN next have a cervical smear?
6 months after treatment
