Cervical Cancer Flashcards
cancer of female reproductive system that is staged clinically
cervical cancer (C linically = C ervical); allows staging to occur in low resource setting
primarily spreads locally and via lymphatics
squamous cell carcinoma of the cervix
may spread hematogenously (3)
- adenocarcinoma cervix
- neuroendocrine tumors
- small cell tumors cervix
treatment for cervical cancer is determined by:
clinical stage
cervical cancer incidence can be substantially decreased by:
improving adolescent HPV vaccination rates
Type of screening used for cervical cancer
cervical cytology screening
T or F:
High-risk HPV infection is necessary and sufficient for cervical cancer development
False:
High-risk HPV infection is necessary but INSUFFICIENT for cervical cancer
___ % HPV + women will resolve HPV on own within 24 months (if intact immune system)
90%
HPV __ & __ account for 90% genital warts
HPV 6 & HPV 11
most carcinogenic HPV
HPV 16; (55-60% all cervical cancers)
2nd most carcinogenic HPV
HPV 18 (10-15 % all cervical cancers)
HPV is a __ (shape), ___ (strands), ___ (nucleic acid) virus
circular, ds, DNA virus
RFs for oncogenic HPV:
- immunocompromised (transplant, HIV)
- smoking
- early age at first intercourse
- multiple partners
- other STIs
- low SES (poor nutrition)
Cervical cancer is a fast or slow process?
very SLOW process; may take 30 years to become invasive cancer
accounts for 80% of cervical cancers
squamous cell carcinoma
second most common type of cervical cancer
adenocarcinoma: HPV 16 and 18 are present in 90% of cervical adenocarcinomas
HPV 18 has highest association with what type of cervical cancer?
cervical adenocarcinoma
ages of males and females for HPV vaccination (as recommended by CDC and ACIP)
female: 11-26 y.o.
male: 11-12 with “catch-up” to 26 y.o.
(nonavalent = all 11 and 12 year olds)
types of HPV vaccines (3) and what they cover
quadrivalent: 6, 11, 16, 18
bivalent: 16, 18
nonavalent: 6, 11, 16, 18, 31, 33, 45, 51, 58
efficacy of HPV vaccines (if naive to HPV genotype when vaccinated)
nearly 100%
primary prevention for cervical cancer
HPV vaccine
secondary prevention for cervical cancer
cervical cytologic screening
initial screening for cervical cancer begins at age:
21
cervical cytology screening recommendations:
initial at age 21; every 3 years ages 21-65
reason for not screening for cervical cancer prior to age 21
- 90% HPV infections are naturally resolved within 24 mos in healthy adolescents
- adolescent cervix is immature and has higher incidence of HPV-related dysplasia
- unnecessary treatment has economic, emotional and future childbearing implications (sig. increase in premie births)
Exceptions for cervical cytology screening recommendations:
- immunosuppressed
- HIV
- DES exposure in utero
- prior cervical cancer or HG dysplasia treatment
symptoms of cervical cancer include:
- abnormal bleeding (b/w periods, w/ intercourse, after menopause
- unusual vaginal discharge
- leg pain, pelvic pain
- anuria
- NONE
diagnosis of cervical cancer is made by:
- screening test: cervical cytology
- confirmed by biopsy
- (biopsy is sufficient if visible tumor is present)
20-30% risk of CIN 3+ over 5 years is predicted by:
HPV 16 persistence of 1-2 years
30% probability of invasive cervical cancer over 30 years is predicted by:
untreated CIN 3 (VERY SLOW) (treated has 1% probability)
T or F: Debulking is used for treating cervical cancers
False: spread is wide and is difficult to get negative margins with debulking
Pattern of spread for cervical cancers:
- local invasion or distant mets?
- lymphatic or hematogenous?
- retro or intraperitoneal?
- local invasion
- lymphatic spread (SCC) AND hematogenous spread (adenocarcinoma, NE tumor, small cell tumor)
- intraperitoneal invasion (spread wide to pelvic wall) = poor prognosis
cervical cancer limited to cervix is stage:
I
cervical cancer in pelvic side wall and/or lower third of vagina is stage:
III (5 yr survival = 47-50%)
cervical cancer in adjacent organs and beyond true pelvis is stage
IV(20-30% 5 yr)
cervical cancer in uterus/parametria/vagina
stage II
treatment of cervical cancer with distant mets (IV):
systemic chemotherapy
radical hysterectomy with pelvic LN dissection is performed in stage ___ cervical cancer
early stage (1-1B)
chemoradiation as main therapy is indicated in ___ stage cervical cancer
locally advanced (1B2-4A)
Recurrence rate is ___ within 2 years
80% (really only get 1 shot at treating)
Favorable prognostic factors for recurrence
- localized, ventral pelvis
- disease free interval > 6 mo
- size
-pelvic exenteration is indicated if:
and involves:
- isolated central recurrence
- removal of all pelvic reproductive organs, bladder, distal ureters, pelvic floor, rectum, anus
- reconstruct via urostomy, colostomy and possibly vagina
