Cervical Cancer Flashcards
What are the two main types of cervical cancer?
What are their precursor lesions?
Which type is more common?
Sqamous cell carcinoma - cervical intra-epithelial neoplasia (CIN)
Adenocarcinoma - cervical glandular intra-epithelial neoplasia (CGIN)
Squamous cell carcinoma
Where do squamous cell carcinomas arise on the cervix?
Where do adenocarcinomas arise on the cervix?
The squamous epithelium lining the ectocervix
The glandular epithelium lining the endocervix
How are a high proportion of cervical cancers diagnosed?
What symptom does it usually present with and who in?
In asymptomatic women, picked up on cervical screening
Abnormal vaginal bleeding (post-coital, inter-menstrual, irregular or persistent) in pre-menopausal women
What are some symptoms which may be seen in advanced cervical cancer?
Pelvic pain
Back pain
Urinary or faecal leakage
Weight loss
Examination early on in cervical cancer can be what?
What usually happens if the cervical cancer is touched on examination?
How may a palpable cervical tumour be described?
Normal
It will bleed
Hard, craggy, asymmetrical
Which type of cervical cancer is more likely to be picked up on cytology at screening?
Which has a better prognosis?
What are some things that differ about who may get adenocarcinoma of the cervix vs squamous cell carcinoma?
SCC
SCC
It is more likely to be seen in individuals of a higher socioeconomic status, with a later onset of sexual activity
What is the most common aetiology of cervical cancer?
This causes interference with what sort of gene?
What does this cause?
HPV, mostly types 16 and 18
Tumour suppressors
Increased cellular turnover and inhibition of apoptosis
In the majority of women who pick up HPV infection, what happens?
What are some factors which increase the risk of the infection becoming chronic?
Most cases are self-limiting and clear spontaneously
Being a smoker or being immunocompromised
What are some risk factors for the development of cervical cancer?
Low socioeconomic status
Early age of first onset of sexual activity
Multiple sexual partners
STIs
High parity
What are some factors which are protective against the development of cervical cancer?
HPV vaccination
Regular cervical screening
Barrier contraception use
Monogamy/abstinence
Circumcision of male partners
When are women screened for cervical cancer?
Between ages 25-64
Every 3 years aged 25-49
Every 5 years thereafter
Who is the HPV vaccination given to?
This must be given before what, in order for it to be effective?
Girls aged 12-13
Before the sexual debut
When a precursor lesion for cervical cancer is found, what should be done about it?
How long does it take for HPV infection to become high grade CIN/CGIN?
How long does it take for high grade CIN/CGIN to become invasive cervical cancer?
They should be treated then, in order to prevent the development of cervical cancer
6 months - 3 years
5 - 20 years
What are the main investigations for suspected cervical cancer?
Colposcopy (and biopsy)
MRI pelvis
Staging investigations (cystoscopy/proctoscopy under anaesthesia, also CXR if advanced disease is suspected)
When is a colposcopy required?
What type of biopsy is initially taken?
What is the MRI pelvis used for in the diagnosis of cervical cancer?
If cytology results come back abnormal
Punch biopsy
Determines the size of the tumour, assesses spread and involvement of other lymph nodes
Which type of cervical cancers get graded?
What are the options?
SCC
Well/moderately/poorly differentiated or undifferentiated/anaplastic
What is meant by a stage I cervical cancer?
What is meant by a stage II cervical cancer?
Confined to the cervix
Invasion of adjacent organs (but not the pelvic sidewall/inferior third of vagina)
What is meant by a stage III cervical cancer?
What is meant by a stage IV cervical cancer?
Invasion into the pelvic side wall or inferior third of the vagina, causes hydronephrosis or involves the regional lymph nodes
Tumour invades the bladder/bowel mucosa or extends outwith the true pelvis
What are some examples of local structures where a cervical cancer may spread to?
Uterine body
Vagina
Bladder
Ureters
Rectum
Which lymph nodes is a cervical cancer most likely to spread to?
What are some distant structures that a cervical cancer may spread to haematogenously?
Para-aortic or pelvic
Lung, liver, bone
What does the management for cervical cancer depend on?
The stage of the disease, and the patients desire for future fertility
What is the main management for early stage cervical cancer (mainly confined to the cervix)?
What may be used as adjuvant treatment to this?
Surgery
Chemotherapy
What is the management of later stage cervical cancer, when the tumour is outwith the cervix?
Chemotherapy weekly with cisplatin
Pelvic external beam radiotherapy
Brachytherapy
What are some fertility sparing treatment options for cervical cancer?
LLETZ (loop diathermy)
Cone biopsy
Trachelectomy
The prognosis of cervical cancer is variable depending upon the stage. What are some potential long term complications?
Bone or nerve pain
Vesicovaginal or rectovaginal fistulae
Ureteric obstruction and consequent renal failure
Where does CIN occur?
What does it actually cause?
Does it cause symptoms?
What is the stage before CIN1 known as?
How many stages of CIN are there?
The squamo-columnar junction
Dysplasia of squamous cells
No, only picked up on cervical screening
Koilocytosis
CIN1 - CIN3
What are the three main histological factors are used to determine what type of CIN is present?
What factor if present indicates HPV infection?
Delay in maturation/differentiation
Nuclear abnormalities
Excess mitotic activity
Koilocytosis
What is the main differentiating factor between different types of CIN?
Mainly how much of the epithelium is involved:
Abnormal cells occupy the basal 1/3rd only = CIN1
Abnormal cells extend into the middle 1/3rd = CIN2
Abnormal cells occupy the full thickness of the epithelium = CIN3
