Cervical Cancer Flashcards
List some of the risk factors for Cervical cancer
HPV (Typically 16&16)
Smoking
HIV
Increased estrogen
What is the therapy used during colposcopy
LLETZ
large loop excision of transformation zone
What determined the formation of transformation zone (2)
Direct in growth of original squamous epithelium bordering the columnar epithelium
Squamous metaplasia- Proliferation of undifferentiated subcolumnar reserve cellls into squamous epithelium.
How often must women be screened for cervical cancer
Over age 30, 3 free Pap smears 10 years apart
Annually for HIV + women
Which HPV types are commonly associated with genital warts and skin infections (2)
HPV 6 and 11
Which HPV types are associated with cervical cancer (2)
HPV 16 and 18
How would you manage a patient with Pap smear showing ASCUS
If cervix is normal and asymptomatic pt treat obvious infx of Lower genital tract
Repeate Pap In 12 months
If same dx three times conservatively refer for colposcopy
How would you manage a patient with Pap smear showing ASC-H
Refer for colposcopy
How would you manage a patient with Pap smear showing LSIL
Repeat two Pap smear on 2 ocasions 6-12 months apart. If persists, colposcope
How would you manage a patient with Pap smear showing HSIL
Colposcopy
What is colposcopy
Cervix is magnified and illuminated after application of 3-5% acetic acid
What is the criteria for therapeutic intervention in woman screened positive for cervical cancer (5)
See booklet (pg 79)
- Diagnostic modalities of abnormal cervix all show same results
- The entire extent of abnormal area can be identified
3.There is no evidence of occult micro invasion - The endocervix is normal on cytology
- There is available colposcope for pt with abnormal Pap
What is the criteria for diagnostic cone biopsy (5)
There is no:
- Diagnostic modalities of show disparities
- The entire extent of abnormal area cannot be identified
3.There is evidence of occult micro invasion - The endocervix is abnormal on cytology
- Abnormal cells on cytology
- There is available colposcope for pt with abnormal Pap
(Opposite of everything above basically)
Differences between LLETZ and cone biopsy (2)
LLETZ is for therapeutic interventions and cone biopsy is for diagnostic
LLETS excisions is 7-10mm and cone biopsy takes 2.5cm
Which vaccine can you give for HPV 16 and 18
Cervarix
Which vaccine can you give for HPV 6 and 11
Gardasil
List the classification of cervical cancer (3)
Squamous cell carcinoma
Adenocarcinoma
Other epithelial tumours
Outline the FIGO classification of cervical cancer
1 (cancer strictly confined to cervix)
A: less of equal to 5mm
B: more than 5mm
- (Extends beyond cervix but not to pelvic side wall)
A: Cancer extends beyond cervix but not to pelvic wall, involves upper third of vagina
B: parametral but not to pelvic side wall
3 (Extends to pelvic side wall)
A: involved lower third of vagina
B:Extends to pelvic side wall
4
A: Spreads to adjacent organs
B: Spread to distant organs
Outline the clinical presentation of a woman with cervical cancer (5/6)
Asymptomatic
Abnormal bleeding
Offensive discharge
Pelvic pain
Malignant vesical or rectal fistula
Symptoms die to metastasis
Discuss the treatment options according to the staging of cervical cancer
Stage 1A: Hysterectomy and pelvic lymphadenectomy
Stage 1B: Radical hysterectomy and bilateral pelvic lymphadenectomy (involves cutting off uterus, vagina at 2cm and both parametric and lymph nodes)
Stage 1B2: Primary radical chemoradiation
Stage 2 and 3: Primary radical chemotheradiation
Stage 4: palliative radiotherapy
