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3. Y5 Zero to finals: O&G > 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
Who can do the smear test for Cervical Cancer screening?
Practice nurse
26
What are smear samples tested for before the cells are examined?
High-risk HPV
27
What happens next depending on the result of the High-risk HPV testing on the smear sample?
* HPV negative = cells NOT examined --\> continue routine screening * HPV positive = cells examined (cytology)
28
What happens next depending on the cytology of the HPV positive smear?
* Normal cytology: repeat HPV test after 12 months * Abn cytology: refer for colposcopy
29
How are abn areas of cervix differentiated in Colposcopy?
Using stains
30
What are the different stains used in Colposcopy? (2 things)
1. Acetic acid 2. Iodine
31
What will you see in Colposcopy with Acetic Acid?
Abn cells = white (called acetowhite)
32
What will you see in Colposcopy with Iodine?
1. Healthy cells = brown 2. (Abn areas won't stain)
33
How can you get a tissue sample during Colposcopy? (2 things)
1. Punch biopsy 2. Large Loop Excision of the Transformational Zone (LLETZ)
34
What anaesthetic can LLETZ done under?
Local
35
What does LLETZ involve?
Using loop of wire w electrical current (diathermy) to remove abn epithelial cervix tissue
36
What are the side fx of LLETZ? (3 things)
1. Bleeding 2. Abn discharge 3. Increased risk of Preterm labour
37
What should be avoided after LLETZ and why? (2 things)
1. Intercourse 2. Tampon use (to reduce infection risk)
38
What staging system is used for Cervical Cancer?
FIGO (International Federation of Gynaecology and Obstetrics)
39
What are the FIGO stages of Cervical Cancer?
* 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
What are the Mx options for CIN / Early stage 1A Cervical Cancer? (2 things)
1. LLETZ 2. Cone biopsy
41
What is Cone biopsy?
Tx for CIN / Early Stage 1A Cervical Cancer
42
What anaesthetic is Cone biopsy done under?
General
43
What does Cone biopsy involve? (2 steps)
1. Cone shaped piece of cervix removed w Scalpel 2. Sample sent for histology to assess for malignancy
44
What are the side fx of Cone biopsy? (5 things)
1. Pain 2. Bleeding 3. Inf 4. Scar formation w Stenosis of cervix 5. Increased risk of Miscarriage / Premature labour
45
What are the Mx options for Stage 1B / 2A Cervical Cancer? (4 things)
1. Radical hysterectomy 2. Removal of local lymph nodes 3. Chemo 4. Radio
46
What are the Mx options for 2B - 4A Cervical Cancer? (2 things)
1. Chemo 2. Radio
47
What are the Mx options for 4B Cervical Cancer? (4 things)
1. Surgery 2. Radio 3. Chemo 4. Palliative care
48
What is the Surgical Mx option for 4B Cervical Cancer?
Pelvic extenteration
49
What is removed in Pelvic exenteration? (7 things)
Most / All pelvic organs: 1. Vagina 2. Cervix 3. Uterus 4. Fallopian tubes 5. Ovaries 6. Bladder 7. Rectum
50
Why are early detection and screening programmes for Cervical Cancer so important? (2 points)
* 5 year survival of Stage 1A: 98% * 5 year survival of Stage 4: 15%
51
What chemo is used for Cervical Cancer?
Bevacizuman (Avastin)
52
What is Bevacizumab (Avastin)?
Monoclonal antibody
53
What types of Cervical Cancer is Bevacizumab (Avastin) used for? (2 things)
1. Metastatic 2. Recurrent
54
What does Bevacizumab (Avastin) target?
Vascular Endothelial Growth Factor A (VEGF-A) --\> responsible for new blood vessel dev (so dis tx stops dis)
55
What vaccine is used to protect against HPV?
Gardasil
56
When should Gardasil vaccine be given to people?
When they're kids before they're sexually active
57
What strains of HPV does Gardasil protect against? (4 things)
6, 11, 16, 18
58
What are the HPV strains 6, 11, 16 and 18 responsible for? (2 things)
1. 6 + 11 = Genital warts 2. 16 + 18 = Cervical Cancer

3. Y5 Zero to finals: O&G (27 decks)

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