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REPRO > Cervical cancer > Flashcards

Cervical cancer Flashcards

1
Q

Types of cervical cancer

A

squamous carcinoma ~75%

adenocarcinomas

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2
Q

Cervical cancer oncogenesis

A

Viral transformation of surface epithelial cells by high risk HPV 16, 18, 31
2 viral gene products (E6, E7) interact with p53 and pRB –> affect control mechanism of cell cycle

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3
Q

Natural history of cervical cancer

A

Dysplasia - mild/moderate/severe
Carcinoma in situ
micro-invasive carcinoma

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4
Q

Risk factors of cervical cancer

A 
HPV, smoking
squamous cell requires sexual intercourse
Early sex (
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5
Q

Spread of cervical cancer

A

local extension

lymphatics

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6
Q

SSx of cervical cancer

A

bleeding

discharge

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7
Q

Diagnosis of cervical cancer

A

Biopsy: suspicious lesions regardless of cytology
Colposcopy: magnifying instrument
Cone biopsy: suspicious or + cytology and no lesion found

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8
Q

Staging of cervical cancer

A

clinical

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9
Q

Tx cervical cancer - early

A

cryotherapy
laser therapy
electrosurgical loop excision

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10
Q

Tx cervical cancer, Stage

A

cone biopsy

hysterectomy + nodes

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11
Q

Tx cervical cancer, late >Ib2 (locally advanced)

A

radiation +/- chemo

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12
Q

Followup cervical cancer

A

adjuvant radiotherapy if pelvic nodes are involved
extension outside cervix
close margins

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13
Q

Squamocolumnar junction development until puberty

A

originally situated in region of external os
Before puberty: pH is alkaline; afterwards, breakdown of glycogen in vaginal/cervical squamous epithelium –> acidic pH
Puberty: endocervical epithelium extends distally into acid environment of vagina, forms ectropion
Transformational zone forms as squamous epithelium regrows over ectropion
penings of crypts may be obliterated in process and result in formation of mucus-filled Nabothian follicles

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14
Q

Transformation zone of the cervix

A

Zone of metaplastic squamous epithelium that extends from original squamocolumnar jxn to current squamocolumnar jxn –> new squamous epithelium in area previously columnar
Increasing age: squamocolumnar jxn moves superiorly as metaplastic squamous epithelium replaces endocervical glandular epithelium (jxn higher up in cervix)

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15
Q

Pap smear sampling

A

Do not use lubricant
If squamocolumnar jxn is visible: rotate spatula through 360, fixation not necessary
If not visible: spatula for exocervix. Cytobrush 180 degrees for endocervix; smear and fix

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16
Q

Pap smear cautions/clinical notes

A

Cytobrush not recommended in pregnant patients
If clinically suspicious specimen seen - biopsy immediately
reschedule if menstruation/infection present
Irregular bleeding may be a symptom of gynecological malignancy –> do a pelvic examination + appropriate investigations

17
Q

Ideal patient conditions for screening

A

Patient has not douched vagina for 48 h before screening
Patient has avoided use of contraceptive creams/jellies for 48 h
Smears not recommended during menstruation
mid-cycle optimal
Patient should be informed that date of LMP is required

18
Q

Cervical cancer screening recommendations - starting

A

Onset of sexual activity/soon after (21, or +3 after onset of sexual activity)
Smear q12 mo until 3 consecutive normal, then continue q24 mo

19
Q

Cervical cancer screening recommendations - abnormal cytology

A

Mild dyskaryosis: repeat 6 mo. Colopscopy recomm if mild atypia persists for 2 y
Moderate/higher dyskaryosis: colposcopic exam recommended

20
Q

Cervical cancer screening recommendations - older

A

> 69 y:
stop screening if >=3 normal smears in the last 10 y and no history of previous significant abnormality (moderate atypia or higher)

21
Q

Cervical cancer screening recommendations - special populations

A

Pregnant women:

  • if no history of previous Pap, do Pap
  • otherwise follow guidelines of normal popn

HIV positive:

  • repeat smear in 6 mo until 2 consecutive normal smears
  • then continue q12 mo
22
Q

Dysplasia

A

Histological finding

need biopsy for structure

23
Q

Dyskaryosis

A

Cytological abnormality

result from Pap smear

24
Q

Mild squamous dyskaryosis/mild endocervical glandular atypia management

A

Repeat smear q6mo
if abnormal cytology persists for 2 y, refer to colposcopy

If mild dysplasia (CIN1) confirmed at colposcopy, follow with repeat Pap in 6 mo

25
Q

Low grade epithelial abnormalities from Pap

A

mild squamous dyskaryosis

mild endocervical glandular atypia

26
Q

High grade epithelial abnormalities from Pap

A 
moderate squamous dyskaryosis
marked squamous dyskaryosis
Suspicious for squamous cell carcinoma in situ
malignant squamous cells
moderate endocervical glandular atypia
marked endocervical glandular atypia
cells suspicious for endocervical carcinoma seen
malignant glandular cells seen
27
Q

High grade epithelial abnormality (Pap) management

A

Refer to colposcopy and directed biopsy

If moderate dysplasia/severe dysplasia/carcinoma in situ (CIN2-3) confirmed, tx by gynecologist
If microinvasion present, refer to gyne/gyne oncologist
If frank invasion present, refer to gynecologic oncologist

28
Q

Cervical ca Stage I

A

confined to cervix

29
Q

Cervical ca stage II

A

beyond uterus but not to the pelvic wall/lower 1/3 of vagina

30
Q

Cervical ca stage III

A

extends to pelvic wall, and/or involves lower 1/3 of vagina and/or causes hydronephrosis or non-functioning kidney

31
Q

Cervical ca stage IV

A

carcinoma has extended beyond true pelvis or has involved (biopsy proven) the mucosa of the bladder/rectum

32
Q

LSIL

A

low grade squamous intraepithelial lesion

  • possible cervical dysplasia
  • usually associated with CIN-1 on biopsy
  • likely caused by HPV infection
  • watchful waiting
  • can do colposcopy if HPV +ve, or repeat cytology in 6 mo
  • low risk of invasive cancer
33
Q

HSIL

A

high-grade squamous intraepithelial lesion
possible cervical dysplasia
associated with CIN2, 3, or carcinoma-in-situ
follow up with colposcopy and biopsy
tx usually LEEP/cryotherapy/laser ablation
2% associated with current invasive cancer
20% will proceed to invasive ca without treatment

34
Q

CIN1

A

corresponds to LSIL cytology
mild dysplasia and abnormal cell growth (minimal)
confined to basal 1/3 of epithelium
corresponds with HPV infection - can be transient/cleared by immune activity
If not cleared, can progress to CIN-2

35
Q

CIN-2

A

moderate dysplasia
spans more than 2/3 of epithelium or up to full thickness
can sometimes be called cervical carcinoma in-situ
can progressive to invasive cancer

36
Q

HPV vaccine efficacy

A

bivalent/quadrivalent prevent 70% of cervical cancers

but difficult to get everyone to have 3 doses, so lower efficacy irl

37
Q

Spontaneous clearing of HPV infection

A

majority cleared within 24 mo

REPRO (18 decks)

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