Cervical cancer Flashcards
Who is most commonly affected by cervical cancer
Younger women in reproductive years
What are the most common forms of cervical cancer
Squamous cell carcinoma (80%) - Epithelium
Adenocarcinoma - Glandular
Small cell (rare)
What is the most common cause of cerical cancer?
HPV infection
What cancers are associated with HPV infection?
Anal
Vulval
Vagina
Penis
Mouth
Throat
How is HPV spread
Sexually
What are the 2 main strains of HPV that cause cervical cancer?
16 and 18
How can HPV cause cervical cancer
HPV produces E6 ad E7 proteins, which inhibit the P53 (6) and pRb (7) tumour suppressor genes
How can risk factors for cervical cancers be divided?
Increased risk of catching HPV
Later detection of precancerous changes
Others
What are some factors that increase risk of catching HPV
- Early sexual activity
- Increased number of sexual partners
- Sexual partners who have had more partners
- Not using condoms
What is the main cause of later detection of pre-cancerous changes in cervical cancer
Non-engagement with cervical screening
What are some other risk factors for cervical cancer?
- Smoking
- HIV(patients with HIV are offered yearly smear tests)
- Combined contraceptive pilluse for more than five years
- Increased number offull-term pregnancies
- Family history
- Exposure todiethylstilbestrolduring fetal development (this was previously used to prevent miscarriages before 1971)
How are most cases of cervical cancer found?
During cervical smears (Usually as a precancerous lesion)
What are some symptoms that suggest cervical cancer
- Abnormal vaginal bleeding (intermenstrual,postcoitalorpost-menopausal bleeding)
- Vaginal discharge
- Pelvic pain
- Dyspareunia (pain or discomfort with sex)
What should be done if symptoms suspicious of cervical cancer are found
Cervical examination with speculum
Swabs to exclude infection
What should be done is the cervix appears abnormal on speculum exam
Urgent cancer referral for colposcopy
What are some cervical features suspicious of cervical cancer
- Ulceration
- Inflammation
- Bleeding
- Visible tumour
What are the 2 forms of premalignant lesions for cervical cancer
Cervical intraepithelial neoplasia (CIN)
Cervical glandular intraepithelial neoplasia (CGIN)
What is CIN?
A pre-invasive stage of cervical cancer, in which there is dysplasia of the squamous cells at the transformation zone
What is CGIN?
A pre-invasive stage of cervical adenocarcinoma, affecting the glandular cells at the transformational zone
How many stages of CIN are there
3
CIN stage 1
mild dysplasia, affecting 1/3 the thickness of the epithelial layer, likely to return to normal without treatment
CIN stage 2
moderate dysplasia, affecting 2/3 the thickness of the epithelial layer, likely to progress to cancer if untreated
CIN stage 3
severe dysplasia, very likely to progress to cancer if untreated
(Cervical carcinoma in situ)
What is the name for pre-cancerous changes on smear test?
Dyskaryosis
What is involved in smear testing
A small brush is used to collect cells from the transition zone of the cervix
What tests are performed in a smear test
1st - High-risk HPV
If positive
2nd - Cytology
What is the Scottish cervical screening process
Smear test every 5 years from ages 25-64
What are some exceptions to the cervical screening programme
- HIV (Anual screening)
- > 65 (Still screened if no screening since 50)
- Women with previous CIN (Require additional tests)
- Immunocompromised women
- Post-partum women (Screening should wait until 12 weeks)
What are some cytology results
- Inadequate
- Normal
- Borderline changes
- Low-grade dyskaryosis
- High-grade dyskaryosis (moderate)
- High-grade dyskaryosis (severe)
- Possible invasive squamous cell carcinoma
- Possible glandular neoplasia
What is done is smear test shows inadequate sample
Repeat after 3 months
What is done if hrHPV is negative
Continue routine screening
What is done if hrHPV is positive but cytology is normal
Repeat HPV test after 12 months
What is done if hrHPV is positive with abnormal cytology
Colposcopy
What is involved in colposcopy
Speculum examination with colposcope to magnify the cervix
What are some stains used in colposcopy
Acetic acid
Iodine
What is acetic acid used for in colposcopy
Shows abnormal cells as white (Acetowhite)
CIN and cervical cancer cells turn white due to increased nucleus:cytoplasmic ratio
What is Schiller’s iodine test used for in colposcopy
Stains normal cells brown, with abnormal tissue not staining
What are some tissue sampling methods that can be used during colposcopy?
Large Loop Excision of the Transformational Zone (LLETZ)
Cone biopsy
What is involved in LLETZ
Local anaesthetic given
Electrically charged wire used to remove abnormal tissue and cauterise the tissue
What are some side-effects or risks of LLETZ
Bleeding
Abnormal discharge
Pre-term labour
What should be avoided after LLETZ
Intercourse
Tampon
(Risk of infection)
What is the treatment of CIN and very-early stage?
Cone biopsy or LLETZ
What is involved in cone biopsy
General anaesthetic
Surgeon removed a cone-shaped piece of the cervix using a scalpel
This is also sent for histopathology
What are some risks of cone biopsy
- Pain
- Bleeding
- Infection
- Scar formation withstenosisof the cervix
- Increased risk of miscarriage and premature labour
What is FIGO stage 1 cervical cancer
Confined to cervix
What is FIGO stage 2 cervical cancer
Invades the uterus or upper 2/3rds vagina
What is FIGO stage 3 cervical cancer
Invades the pelvic wall or lower 1/3 of vagina
What is FIGO stage 4 cervical cancer
Invades the bladder, rectum or beyond the pelvis
Management of stage 1B-2A cervical cancer
Radical hysterectomy and removal of local lymph nodes with chemotherapy and radiotherapy
Management of stage 2B-4A cervical cancer
Chemotherapy and radiotherapy
Management of stage 4B cervical cancer
Management may involve a combination of surgery, radiotherapy, chemotherapy and palliative care
What is the 5 year survival rate for cervical cancer?
1A = 98%
4 = 15%
What is pelvic exenteration?
an operation that may be used in advanced cervical cancer. It involves removing most or all of the pelvic organs, including the vagina, cervix, uterus, fallopian tubes, ovaries, bladder and rectum. It is a vast operation and has significant implications on quality of life.
What is Bevacizumab (Avastin)
a monoclonal antibody that may be used in combination with other chemotherapies in the treatment ofmetastaticorrecurrentcervical cancer. It is also used in several other types of cancer. It targetsvascular endothelial growth factor A(VEGF-A), which is responsible for the development of new blood vessels. Therefore, it reduces the development of new blood vessels.
When is the HPV vaccine given?
Given ages 9-26, but most effective ages 11-12
Should be given before they become sexually active
What is the current NHS HPV vaccine
Gardasil
Covers strains 6, 11, 16 and 18
What are the 3 surgical management options for cervical cancer?
Trachelectomy
Simple hysterectomy
Radical hysterectomy
What is trachelectomy
Removal or the cervix with a margin
This is then sutured closed (Fertility maintained with C-section birth)
What are the most common chemotherapy drugs used in cervical cancer
Cisplatin
Carboplatin + Paclitaxel
