Cervical cancer Flashcards

1
Q

What is the natural history of cervical cancer?

A

1 - Infection with HPV (16 & 18 most common in cervical cancer cases)

2 - HPV becomes incorporated into host cell

3 - HPV persists for between 2-3 years

4 - Cervical Intraepithelial Neoplasia (CIN) develops

5 - Within around 10 years, CIN can then go to develop into cervical cancer

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2
Q

How does the UK HPV Immunisation programme work?

A

All girls between 12-18 are offered the vaccine against HPV 6,11,16,18

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3
Q

What is the difference between CIN and Cervical cancer?

A

CIN - Cells still within the basement membrane

Cervical cancer - Cells have spread into surrounding stroma and can spread around into lymph nodes

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4
Q

What is the age of peak prevelance of HPV infection?

A

15-25 years

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5
Q

In what way can the Cervical cancer screening programme prevent cervical cancer?

A

Primary prevention - HPV detection (will become part of routine cervical screening checks in 2019)

Secondary prevention - Detect viral lesions and CIN

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6
Q

What factors can increase a womans risk of developing cervical cancer?

A

Smoking

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7
Q

How is a woman with a positive cervical screening result managed?

A
  • Following a +ve test for changes in the cells of the cervix, the sample will also be tested for high risk HPV (16 & 18) if the cell changes are moderate
  • If HPV is also found, the patient will be referred for colposcopy
  • If the cervical screening test finds significant cellular changes then the patient will be automatically referred for colposcopy without testing for HPV 16 & 18
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8
Q

How often are woman invited for cervical screening in the UK?

A

25-49 years old - screened every 3 years

50-64 - screened every 5 years

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9
Q

Which cervical smear results are sent for cytology?

A

Those which are HPV +ve

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10
Q

From where in the cervix are cells taken for cytological assessment?

A

Transformation zone

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11
Q

What changes does the cervical epithelium undergo in cervical intraepithelial neoplasia and cervical cancer?

A
  • Columnar epithelium changes into squamous epithelium due to increase in stromal fluid
  • This means that the squamo-columnar junction moves higher up in the transformation zone
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12
Q

What are the risk factors for cervical cancer?

A

HPV Infection

Smoker

Multiple sexual partners

Prolonged OCP use

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13
Q

What investigations are performed to diagnose cervical cancer?

A

Colposcopy with biopsy

Speculum examination of cervix

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14
Q

What are the symptoms of cervical cancer?

A

Vaginal bleeding

Post-coital bleeding

Vaginal discharge

Intermenstrual bleeding/PMB

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15
Q

What are the stages of cervical cancer and their cure rates?

A

1a - 99%

1b - 85%

2a - 75%

2b - 60%

3b - 33%

4 - 15%

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16
Q

How is cervical cancer treated?

A

1 - Radical hysterectomy (stages 1b-2a)

2 - Radiotherapy and chemotherapy (2b and above)

17
Q

Which virus is most commonly associated with cervical cancer?

A

HPV 16 & 18

18
Q

What is the pre-cancerous form of cervical cancer?

A

Cervical Intraepithelial Neoplasia (CIN)

19
Q

The abnormalities of which cells can be detected from cervical smears and what are these abnormalities known as?

A

Squamous cells

Squamous Intraepithelial lesion

20
Q

The transformation zone in the cervix seperates which 2 types of epithelium?

A

Squamous

Columnar

21
Q

What is the term used to describe abnormal cells of the cervix?

A

Dyskaryosis

22
Q

If a cervical screening test revealed a high-grade dyskariosis, what should be the next step?

A

Colposcopy

23
Q

What type of cancer is cervical cancer?

A

Squamous cell carcinoma

24
Q

What are the steps taken once a small cell change and a significant cell change has been identified from a cervical screening test?

A

Small cell change:

  • Check for HPV
  • If HPV found, refer for colposcopy

Significant cell change:

  • Refer for colposcopy without checking for HPV