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
