Cervical cancer Flashcards

1
Q

Most common histological type

A

Squamous cell carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Risk factors

A
STDs
Multiple sexual partners
High parity
Smoking
OCP
Early first coitus
Immunosuppression
HIV
HPV infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Presentation

A
abnormal vaginal bleeding (common)
postcoital bleeding (common)
pelvic pain, dyspareunia (uncommon)
cervical mass (uncommon)
cervical bleeding (uncommon)
mucoid discharge
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Pathogenesis

A

HPV acts via E6 and E7 genes,
which differ in high vs. low risk HPV types;
HPV is integrated in premalignant lesions with tumor DNA vs.
present in episomes (not integrated) in condylomas;
in HPV 16 and 18, E6 binds to p53,
causing its proteolytic degradation;
E7 binds to retinoblastoma gene (Rb) and
displaces transcription factors normally bound by Rb
Other co-factors are important, because (a) most with HPV don’t get cervical cancer,
(b) 10-15% of cervical cancer is NOT associated with HPV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Age group

A

Ten year premalignant stage

Age: 40-50

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Clearance rates of HPV

A

Eight months: 50% cleared

2 years: 90% cleared

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Regression rates

A

CIN 1 >95%

CIN 3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Depth of prominent nuclei and CIN classification

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Endocervical polyp: % women, epidemiology, presentation

A

2-5% of adult women
Usually multigravida age 30-59 years
Produces bleeding or mucoid discharge
Probably secondary to chronic inflammation and not neoplastic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Gross features

A

Exophytic
Infiltrative
Ulcerative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Where does it metastasise to

A

Lung
Liver
Bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Clinical assessment

A

Pap smear->asymptomatic
Colposcopy->symptomatic/abnormal smear
Biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Prognosis

A

Stage IA1 - 100%
Stage IB2-IIB - 50% to 70%
Stage III - 30% to 50%
Stage IV - 5% to 15%.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Causes of death

A

Uremia
Hemorrhage
Sepsis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Investigations

A

1st tests to order
vaginal or speculum examination
colposcopy, biopsy, HPV testing

Tests to consider
FBC, renal function testing
liver function tests (LFTs)
CXR, IVP, barium enema?
proctoscopy, cystoscopy
MRI pelvis, PET whole body
PET/CT whole body
CT of chest/abdomen/pelvis 
with IV/oral contrast
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Management

A

non-pregnant stage IA1: pre-invasive disease
1st line: local excision
adjunct: hysterectomy or chemoradiation

non-pregnant stage IA2-IB1: early stage disease
>2 cm or not desiring fertility: surgical candidate
1st line: radical hysterectomy + lymphadenectomy
adjunct: postoperative chemoradiation
>2 cm or not desiring fertility: non-surgical candidate
1st line: chemoradiation

17
Q

Chemotherapy agents

A

Cisplatin

Paclitaxel

18
Q

anti-VEGF agent

A

Bevacizumab

19
Q

Follow up

A

3- to 6-monthly clinical review, physical exam, and cervical/vaginal cytology in the first 2 years, then every 6 to 12 months for 3 to 5 years. An annual CXR is recommended for 5 years.

report significant symptoms (pain, bleeding, swelling) early

20
Q

Staging

A

Stage 1: cervix only
Stage 2: beyond cervix, not affixed to pelvic wall, not involving lower 1/3 vagina
Stage 3: Extends to pelvic wall, lower 1.3 vagina
Stage 4: Extends to mucosa of bladder and rectum