Cervical Cancer Flashcards
What is 8 risk factors for cervical cancer
HPV infection (16 & 18)
Long interval since last PAP smear
Immunosupression
Cigarette smoking
Oral contraceptive
Low SES
Multiple partners
STD infections
What is HPV & where does it make changes
A dsDNA virus that infects the skin & squamous mucosa & make changes to the basal epithelium at transitional zone
What is the 2 categories of HPV
High risk: 16 & 18
Low risk: 6 & 11
What 2 things does low risk HPV cause
Condylomata acuminata
Freelying episome
What does high risk HPV cause
Dysplasia
What is the outcomes of low risk HPV
Regression
What is the outcome of high risk HPV
CIN I/LSIL can regress or if it persist it can become CIN II/III & HSIL
CIN II/III & HSIL can regress but also alongside other factor become cervical cancer
What is the Bethesda grading system
Low grade squamous intraepithelial lesions (LSIL)
High grade squamous intraepithelila lesions (HSIL)
Invasive carcinoma once it crosses the basement membrane & replace underlying tissue
What is the FIGO staging system
Stage I: at the cervix
Stage II: beyond cervix
Stage III: irresectable
Stage IV: disseminated
What is FIGO stage I
Stage IA: only visible with a microscope & <5mm deep
Stage IB: more than 5mm deep
What is FIGO stage II
Stage IIA: upper 2/3 of the vagina
Stage IIB: parametrium
What is FIGO stage III
Stage IIIA: lower 1/3 of vagina
Stage IIIB: pelvic sidewall/non-functional kidneys & hydronephrosis
What is FIGO stage IV
Stage IVA: mucosa of bladder or rectum
Stage IVB: distant sites
What is the 2 screening protocols for cervical cancer
PAP smear/cytology screening
HPV high risk DNA testing
What is a PAP smear/cytology screening
Collecting cells from transitional zone via cervical brush
What is PAP smear/cytology screening interpretation
CIN I/LSIL: repeat after one year
CIN II/III/HSIL: colposcopy
What is HPV high risk DNA testing
PCR for HPV DNA on site & are going to replace Pap smear
For what is HPV high risk DNA testing sensitive
CIN II
Who should go for HPV high risk DNA testing & when
Over 30 years old every 5 years
What is primary prevention of cervical cancer
HPV vaccine
How does the HPV vaccine work
1-3 shots over 6 months & protect against infection by creating neutralizing antibodies
What is the 2 types of HPV vaccine
Cervarix 16 & 18
Gardasil 6, 11, 16 & 18
What should be done when histological confirmed of invasive or precursor lesion
Colposcopy
What is a colposcopy
Direct observation of cervix looking at the margins, color & blood vessel arrangement under magnification
What is the 2 functions of a colposcopy
Determine if lesion present
Perform a biopsy
What is the 2 types of biopsy
Hot wire loop (LLETZ)
Cold knife (cone biopsy)
What is the 3 treatment options for cervical cancer
Surgery
Radiation
Chemotherapy
What is the 3 types of cervical cancer
Squamous cell carcinoma
Adenocarcinoma
Small cell carcinoma
Where does squamous cell carcinoma occur
At transitional zone
Where does adenocarcinoma occur
Endocervical due to HPV infection
What causes small cell carcinoma of the cervix
HPV 18
What is the most common type of cervical cancer
Squamous cell carcinoma
What is the most aggressive type of cervical cancer
Small cell carcinoma
What is the 3 ways in which cervical cancer spread
Local: most common
Lymphatic: iliac nodes
Haematogenous: via vaginal plexus that is a link between systemic & portal circulation
What is the 3 causes of death in cervical cancer w/ examples
Local: renal failure, haemorrhage & superadded infection
Systemic: blood borne metastases
Iatrogenic: pulmonary embolism after pelvic operation
