Cervical Cancer

Question 1

Where cervical cancer rank on worlds most frequent cancers?

Answer 1

4th

Question 2

What % of cervical cancers are related to HPV type 16/18?

Answer 2

71%

Question 3

What instruments are required for a conventional pap smear?

Answer 3

Bivalve speculum
Adjustable light
Cervex sampler or ayres
Microscope slide
Spray fixative
Pencil to label slide

Question 4

What instruments are required for liquid based specimens?

Answer 4

Hologic Thin prep

BD surepath

Question 5

What is the aetiology of SCC?

Answer 5

Sexually transmitted disease

HPV infection most likely cause

Question 6

What are some risk factors for SCC?

Answer 6

Sexual activity

 - Early coitus age
  - Multiple partners

Exposure to high risk males

 - Early age of first coitus
 - Multiple partners
 - Cigarette smoking
 - Prostatitis 
 - Penile HPV infection
 - Carcinoma of penis

Drugs

• Ciggies
• Pill
• Immunosupressive drugs
• Alcohol
• Diethyl stilboestrol
• HPV and HSV infection
• Low socioeconomic

Question 7

What evidence is there for HPV causing SCC?

Answer 7

HPV DNA in more than 80% of carcinomas

HPV DNA in other tumours

Question 8

How many HPV genotypes are there?

Answer 8

> 100
40 commonly infecting genitals
15 carcinogenic

Question 9

What are the main high risk HPV genotypes?

Answer 9

16, = worst = 50% all cancers
18, 
31, 
33, 4
5

Question 10

What are some low risk HPV genotypes?

Answer 10

6
11
40

Question 11

What are the two primary viral oncogenes of HPV?

Answer 11

E6 and E7

Question 12

What does E6 do?

Answer 12

Binds and inhibits p53, inhibing mitosis

Activates telomerase allowing cells to replicate continuously

Question 13

What does E7 do?

Answer 13

Binds retinoblastoma protein (pRb), inactivating transcription factor E2F
Cell can evade cell cycle at G1/S1 transition phase

Question 14

How does HPV infect humans?

Answer 14

Infects cells of basal layer of peithelium at junction between vagina and ectocervix

E1 and E2 proteins in basal layers
E6 and E7 at distal layers

Question 15

When are E1/E4 proteins and L1 and L2 late proteins expressed?

Answer 15

As infected cells differentiate into squamous cells

These represent koilocytes seen on cytology

Question 16

Where are koilocytes seen?

Answer 16

Intermediate and superficial squamous cells (E1 and E4 fusion proteins)
Dense peripheral polychromatic cytoplasm
Nuclear enlargement and hyperchromasia, multinucleation and binucleation

Question 17

What types of vaccination for HPV is there?

Answer 17

Tetravalent, HPV, 6, 11, 16 and 18 (Gardasil)

Bivalent HPV 16 and 18 (Cervarix)

Question 18

What types of Squamous Cell carinomas are there?

Answer 18

Non-keratinising SCC (50%)
- Large cells, may be few keratinising

Keratinising SCC (35%)
 - Well differentiated SCC, single keratinised squamous

Small cell Sq carcinoma (15%)
- Uncommon, poorly differentiated SCC

Question 19

What is the cytology of keratinising SCC?

Answer 19

Tumour cells

• Similar size
• Pleomorphic
• Round, oval, polygonal, spindled
• Keratinised cytoplasm

Nuclei

• Usually no nucleoli
• Coarsely granular chromatin or pyknotic
• often large

Question 20

How is SCC diagnosis made?

Answer 20

Cant usually on pap smear

Requires coolposcopy, biopsy

Question 21

What is prognosis for SCC?

Answer 21

15-85% 5 year surv depending on tumour stage

Question 22

What does the cervical cytology registry do?

Answer 22

The CCR maintains and operates:

• Database of pap + other cervical screening test
• Governed by legislation
• 4.5 mill test results

Safety net-sends reminders to women to get pap
Follows up abnormal results
Linked historys to screening
Clinical support to women
Stats + research
Planning monitoring + evaluation
Quality assurance data