cervical cancer Flashcards
types of cervical cancer
squamous cell - 80%
adenocarcinoma - 20%
most occur between 25-29
HPV serotypes important for the development of cervical cancer
16, 18 + 33
risk factors for cervical cancer
- HPV 16, 18, 33
- smoking
- HIV
- early 1st intercourse / many sexual partners
- high parity
- lower socioeconomic status
- COCP
mechanism of HPV causing cervical cancer
HPV 16 + 18 produce oncogenes E6 + E7
- E6 inhibits p53 tumour suppressor gene
- E7 inhibits RB suppressor gene
cervical cancer presentation
asymptomatic, routine screening
- abnormal vaginal bleeding - postcoital, intermenstrual, postmenopausal bleeding
- vaginal discharge
HPV strains assoc with genital warts
6&11
koilocytes
sign of HPV infection, infected endocervical cells may undergo changes resulting in development of koilocytes
(sign of cervical intraepithelial neoplasia)
koilocyte characteristics under microscope
enlarged nucleus
irregular nuclear membrane contour
nucleus stains darker than normal (hyperchromasia)
perinuclear halo may be seen
staging of cervical cancer
FIGO
I - confined to cervix
- IA - <7mm wide + 3-5mm deep
- IB - >7mm wide + </>4cm diameter
II - beyond cervix but not pelvic wall
III - extension beyond cervix + to pelvic wall
IV - beyond pelvis or involvement of bladder or rectum
management of IA cervical tumours
gold standard = hysterectomy +/- lymph node clearance
maintain fertility = cone biopsy with neg margins
management of IB cervical cancer
<4cm - radio + chemo
–> bacytherapy / cisplatin = chemo agent
> 4cm - radical hysterectomy with pelvic node dissection
management of stage II + III cervical tumours + IV
radiation with concurrent chemo (cisplatin)
IV - same + palliative chemo
complications if cervical cancer mx
cone biopsies + radical trachelectomy = increase risk of preterm birth in future
radical hysterectomy - uteral fistula
radio
short term - bleeding, pain on pee
long term - ovarian failure, lymphoedema, fibrosis of bowel/bladder
how often / what age to patients get screened in scotland
every 5yrs
between 25-64yrs
can you get a cervical smear during pregnancy
nah, delay until 3 months postpartum
(unless previous abnormal smears)
treatment of cervical intraepithelial neoplasia
Large loop excision of transformation zone (LLETZ)
cervical ectropion
elevated oestrogen levels result in a larger area of columnar epithelium being present on the ectocervix
(ovulatory phase, pregnancy, COCP)
transformation zone of cervix
where stratified squamous epithelium meet columnar epithelium of cervical canal
features + management of cervical ectropion
vaginal discharge / post-coital bleeding
if sx troublesome - ablative treatment (cold coagulation)
what happens if smear sample is “inadequate”
repeat sample in 3 months
if 2 consecutive inadequate samples –> colposcopy
what happens when smear is pos for HPV but cytology is normal
test is repated at 12months
- if neg - return to normal recall
- pos + cytology still normal - test 12months later
