Cervical Cancer Flashcards

1
Q

What are the two main types of cervical cancer?

What are their precursor lesions?

Which type is more common?

A

Sqamous cell carcinoma - cervical intra-epithelial neoplasia (CIN)

Adenocarcinoma - cervical glandular intra-epithelial neoplasia (CGIN)

Squamous cell carcinoma

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

Where do squamous cell carcinomas arise on the cervix?

Where do adenocarcinomas arise on the cervix?

A

The squamous epithelium lining the ectocervix

The glandular epithelium lining the endocervix

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

How are a high proportion of cervical cancers diagnosed?

What symptom does it usually present with and who in?

A

In asymptomatic women, picked up on cervical screening

Abnormal vaginal bleeding (post-coital, inter-menstrual, irregular or persistent) in pre-menopausal women

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

What are some symptoms which may be seen in advanced cervical cancer?

A

Pelvic pain

Back pain

Urinary or faecal leakage

Weight loss

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

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?

A

Normal

It will bleed

Hard, craggy, asymmetrical

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

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?

A

SCC

SCC

It is more likely to be seen in individuals of a higher socioeconomic status, with a later onset of sexual activity

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

What is the most common aetiology of cervical cancer?

This causes interference with what sort of gene?

What does this cause?

A

HPV, mostly types 16 and 18

Tumour suppressors

Increased cellular turnover and inhibition of apoptosis

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

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?

A

Most cases are self-limiting and clear spontaneously

Being a smoker or being immunocompromised

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

What are some risk factors for the development of cervical cancer?

A

Low socioeconomic status

Early age of first onset of sexual activity

Multiple sexual partners

STIs

High parity

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

What are some factors which are protective against the development of cervical cancer?

A

HPV vaccination

Regular cervical screening

Barrier contraception use

Monogamy/abstinence

Circumcision of male partners

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

When are women screened for cervical cancer?

A

Between ages 25-64

Every 3 years aged 25-49

Every 5 years thereafter

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

Who is the HPV vaccination given to?

This must be given before what, in order for it to be effective?

A

Girls aged 12-13

Before the sexual debut

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

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?

A

They should be treated then, in order to prevent the development of cervical cancer

6 months - 3 years

5 - 20 years

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

What are the main investigations for suspected cervical cancer?

A

Colposcopy (and biopsy)

MRI pelvis

Staging investigations (cystoscopy/proctoscopy under anaesthesia, also CXR if advanced disease is suspected)

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

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?

A

If cytology results come back abnormal

Punch biopsy

Determines the size of the tumour, assesses spread and involvement of other lymph nodes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Which type of cervical cancers get graded?

What are the options?

A

SCC

Well/moderately/poorly differentiated or undifferentiated/anaplastic

17
Q

What is meant by a stage I cervical cancer?

What is meant by a stage II cervical cancer?

A

Confined to the cervix

Invasion of adjacent organs (but not the pelvic sidewall/inferior third of vagina)

18
Q

What is meant by a stage III cervical cancer?

What is meant by a stage IV cervical cancer?

A

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

19
Q

What are some examples of local structures where a cervical cancer may spread to?

A

Uterine body

Vagina

Bladder

Ureters

Rectum

20
Q

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?

A

Para-aortic or pelvic

Lung, liver, bone

21
Q

What does the management for cervical cancer depend on?

A

The stage of the disease, and the patients desire for future fertility

22
Q

What is the main management for early stage cervical cancer (mainly confined to the cervix)?

What may be used as adjuvant treatment to this?

A

Surgery

Chemotherapy

23
Q

What is the management of later stage cervical cancer, when the tumour is outwith the cervix?

A

Chemotherapy weekly with cisplatin

Pelvic external beam radiotherapy

Brachytherapy

24
Q

What are some fertility sparing treatment options for cervical cancer?

A

LLETZ (loop diathermy)

Cone biopsy

Trachelectomy

25
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
26
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
27
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
28
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