Cervical cancer Flashcards
80% of cervical cancers are
squamous cell carcinomas
What is the second most common type of cervical cancer
adenocarcinoma
Which types of HPV are most associated with cervical cancer
16 & 18
How does HPV cause cervical cancer
Produce proteins E6&7 that inhibit tumour suppressor genes p53 and pRb
Increased risk of catching HPV occurs with
early sexual activity
increased number of sexual partners
not using condoms
Other than HPV what are some risk factors for cervical cancer (5)
Smoking
HIV
COCP use for >5 years
increased number of full term pregnancies
presenting symptoms that should make you consider cervical cancer (4)
abnormal vaginal bleeding
vaginal discharge
pelvic pain
dyspareunia
Appearances on speculum exam that can suggest cervical cancer (4)
Ulceration
Inflammation
bleeding
visible tumour
dysplasia in the cervix is called
cervical intraepithelial neoplasia
define CIN 1
mild dysplasia
affecting 1/3 the thickness of the epithelial layer
likely to return to normal without treatment
define CIN 2
moderate dysplasia
affecting 2/3 the thickness of the epithelial layer
likely to progress to cancer if untreated
define CIN 3
severe dysplasia
very likely to progress to cancer if untreated
CIN III is sometimes called
cervical carcinoma in situ
What is dyskaryosis in the context of cervical malignancy
cells are examined under a microscope for precancerous changes
When is dyskaryosis performed for cervical malignancy
If high risk HPV is detected
When aged 25-49 cervical smears are performed
every 3 years
When aged 50-64 cervical smears are carried out
every 5 years
Women with HIV should have a smear
annually
pregnant women due a smear should
wait until 12 weeks post partum
Actinomyces-like organisms are often discovered at the smears of women who
have IUD’s
What should be done if a patient’s smear results show an inadequate sample
repeat after at least 3 months
What should be done if a patient’s smear results show that they are HPV negative
continue routine screening
What should be done if a patient’s smear results show normal cytology but HPV negative
repeat after 12 months
What should be done if a patient’s smear results show abnormal cytology and HPV positive
refer for colposcopy
During colposcopy what can be used to differentiate abnormal areas
acetic acid; iodine solution
When using acetic acid in colposcopy abnormal areas
appear white indicating increased nuclear to cytoplasmic ratio
When using iodine in colposcopy abnormal areas
will not stain
What should a woman be warned of after a large loos excision of the transformation zone on colposcopy
not to use a tampon after procedure
increased risk of preterm labour
treatment for CIN
cone biopsy
LLETZ
risk of a cone biopsy (5)
pain
bleeding
infection
scar formation with stenosis of the cervix
increased risk of miscarriage and premature labour
FIGO stage 1 cervical cancer
confined to cervix
FIGO stage 2 cervical cancer
Invades the uterus or upper 2/3 of the vagina
FIGO stage 3 cervical cancer
Invades the pelvic wall or lower 1/3 of the vagina
FIGO stage 4 cervical cancer
Invades the bladder, rectum or beyond the pelvis
monoclonal antibody that may be used with other chemotherapies in the treatment of metastatic or recurrent cervical cancer
Bevacizumab (avastin)
