Cervical Cancer 2

Question 1

What is cervical cancer

Answer 1

Cervical cancer is the second most common type of cancer exclusive to women worldwide. after Breast and before Endometrial and Ovarian

most often squamous cell carcinomas that arise from infection with a high-risk human papillomavirus (HPV) serotype.
preceded by cervical intraepithelial neoplasia (CIN), which can be detected via Pap smear
Usually dg at 48 y/o

Question 2

What are the most common cancers of the female reproductive system

Answer 2

1.cervical
2Endometrial.
3.Ovarian

Mortality

1. Ovarian
2. Cervical
3. Endometrial

Question 3

Aetiology of cervical cancer

Answer 3

Infection with high-risk HPV:16 & 8
Squamous cell carcinoma 15-20%16 (exocervical implantation) more common
75-80% Adenocarcinoma 18 (endocervical implantation)

RF
Early onset of sexual activity/multiple sexual partners (strongest RF)

High parity

Immunosuppression (very common in AIDS d/2 HIV infection)

History of sexually transmitted infections (herpes simplex, chlamydia)

Cigarette smoking /second-hand smoke (for squamous cell cancer only)

Oral contraceptives >5years (possibly d/2 increased sexual activity)

Low socioeconomic status (poor access to Pap smears)

In-utero exposure to diethylstilbestrol (DES) ( used in 1940’s to prevent miscarriage )

Question 4

Pathogenesis of cervical cancer

Answer 4

Sex W/ HPV infected donny

Implantation of HPV in TRANSITIONAL ZONE

Production of oncoproteins

1) E6 → inhibiton of p53 (tumour suppressor)→ inhibition of intrinsic apoptotic pathway
2) E7 →Inhibits retinoblastoma protein (tumour suppressor)→ increased activity of E2F-family of transcription factors

Either 
1) implantation in squamous cells 
-squamaous dysplasia- CIN(1,2&3)
-Doc as Low grade SIL(CIN1) OR high grade SIL(CN2/3)
-CIS
-invasive SCC
 OR 
1)implantation into glandular cells 
-differentiation-dysplasia-
-glandular intro epithelial lesion 
-invasive glandular carcinoma

Question 5

Sx of cervical cancer

Answer 5

Patients are usually asymptomatic in early stages.
Symptoms commonly first appear in advanced disease.
-Abnormal vaginal bleeding: menometrorrhagia, postcoital spotting
-Abnormal vaginal discharge: blood-stained or purulent w/ bad smell
-Cervical ulceration

Late symptoms
-Mass effect
#Hydronephrosis: d/2 compression of the ureters
#Swelling of lower limbs d/2 compression of pelvic veins/lymphatics

-Features of disseminated disease: 
#lymphadenopathy of: 
paraaortic lymph nodes & lymph nodes along the external iliac artery
#metastatic pain of: liver, lungs, pelvic bones and vertebra,and brain. 

Most patients that do not undergo therapy die before distant spread occurs d/2 Prenal metastasis and RENAL FAILURE
Always consider cervical cancer as a cause of postcoital bleeding!

Question 6

Dg of cervical cancer

Answer 6

Pap smear & histology w/ Bethesda system
-scrape areas from transitional zone
-
HPV test
-women > 30 years of age alongside PAP smear
-PCR: detection of HPV DNA

Colposcopy: 3% acetic acid stains normal squamous cells brown d/2 glycogen
-unscrapabable leukoplakia(No glycogen) in & around TZ

Conization : excision of a cone of cervical tissue that contains TZ with Loop Electroexcisional Procedure

Question 7

Complications of dg procedures in cervical CANCER

Answer 7

Intraoperative or postoperative bleeding

Cervical stenosis causing infertility

Cervical insufficiency during pregnancy

Infection, uterine perforation

Question 8

complications of cervical cancer

Answer 8

1)direct complications of the cancer
-hydronephrosis
-RF
-Fistula formation
#recto-vaginal
#vesico-vaginal
-cancer anorexia syndrome
-lower limb oedema

2) complications of radiotherapy
- vaginal stenosis
- radiogenic cystits

Question 9

prevention of cervical cancer consists of ?

Answer 9

primary prophylaxis

1) HPV immunization
2) condoms (partial proph as skin to skin can transmit HPV)
3) abstinence

secondary prophylaxis

• screening via pap smear
• all women aged 21–65 should participat

Question 10

what are the indications of HPV vaccination

Answer 10

Women: 9–26 years of age

Men: 9–21 years of age

Question 11

what are the priniciples of PAP smear screening

Answer 11

21–29 years: Pap smear every 3 years

30–65 years: Pap smear every 3 years OR Pap smear + HPV test every 5 years

> 65 years: no testing required if previous testing was negative

women with DES exposure/ HIV require continued screening