cervical cancer Flashcards
where is the area predisposed to malignant change
transition zone between endocervical canal and vaginal cervix- squamo columnar junction
what is the pre invasive phase
CIN- cervical intra epithelial neoplasia
when are smears done
first is at 25 every 3 years until 49. then 5 yearly unril 65, after that only if one of last 3 were abnormal. HIV +ve - every year
main cause cervical cancer
HPV. Gardasil vaccination
risk factors
prolonged pill use, high parity, many sexual partners, early first coitus, HIV, other STDs, smoking
what is done if there is inflammation (2) on smear
take swab, treat infection, repeat in 6 months.
how many abnormal inflammatory smears until colposcopy
3 abnormal
what is done if there is mild atypia (2)
repeat in 4 months. colposcopy after 2 abnormal
action if smear is mild dyskaryosis
HPV test +- colposcopy
action if smear is moderate or severe dyskaryosis
colposcopy
how is CIN treated
punch biopsies for histology. destroyed by cryotherapy, laser, cold coag, large loop excision of transformation zone
does colposcopy detect adenocarcinoma
no
for how many years does patient need smears after treatment for CIN
10 years
grades of CIN
1- mild dysplasia, 2- moderate, 3- severe/carcinoma in situ
what type of cancers are most of the invasive
squamous. 15-30% are adenocarcinomas especially affecting women
stages of cervical cancer
1- confined to cervix; 2- upper 2/3 vagina; 3- lower 1/3 vagina; 4- spread to bladder and/or rectum; 4b- distant organs
symptoms
non menstrual bleeding. early tumour is firm which bleeds on contact. MRI/CT to stage, PET
treating invasive cancers stages Ia1, Ia2, Ib1
cervical conization (stage Ia1), hysterectomy. stage Ia2 and some Ib1- radical hysterectomy with pelvic lymphadenectomy or radiotherapy
what is the gold standard for stage Ib, II or bulky stage II, III, IV
chemoradiation
main chemo agent
cisplatin. add topotecan for resistant
side effect radiotherapy
causes vaginal stenosis so encourage intercourse within 2 months of treatment
are smears of any value following radiotherapy
no
when is HPV screened for
borderline nuclear change and mild dyskaroysis
