Cervical Cancer Flashcards
1
Q
What is cervical cancer?
A
Cancer arising from the cervix
2
Q
What is the most common type of cervical cancer?
A
Squamous cell carcinoma
3
Q
How does cervical cancer compare to other cancers in terms of prevalence worldwide?
A
3rd most commonly diagnosed world wide
4
Q
How does cervical cancer compare to other cancers as causes of cancer deaths in women?
A
4th most common
5
Q
How many new cases of cervical cancer are there each year in the UK?
A
3000
6
Q
How many cervical cancer deaths are there each year in the UK?
A
850
7
Q
How common is cervical cancer in women in the UK?
A
14th most common cancer in females
8
Q
What % of cervical cancer cases in the UK are considered preventable?
A
99.8%
9
Q
What is the most common age range for diagnosis of cervical cancer?
A
25-34 years old
10
Q
What % of cervical cancers are squamous cell carcinomas?
A
70%
11
Q
What are the other types of cervical cancer?
A
- Mixed pattern (15%)
- Adenocarcinoma (15%)
12
Q
What stages of disease can all subtypes of cervical cancer causes?
A
Pre-invasive and invasive
13
Q
How do most cases of cervical cancer progress to invasive disease?
A
From HPV infection to CIN to invasive disease
14
Q
What does CIN stand for?
A
Cervical intraepithelial neoplasia
15
Q
What is CIN?
A
A cytological diagnosis describing involvement of the epidermis
16
Q
What are the subtypes of CIN?
A
CIN I-III
17
Q
What is CIN I?
A
Disease confined to the lower 1/3 of the epithelium
18
Q
What happens to most cases of CIN I?
A
They regress slowly (some progress)
19
Q
What is CIN II?
A
Disease confined to the lower and middle thirds of the epithelium
20
Q
What is CIN III?
A
Disease affecting the full thickness of the epithelium
21
Q
What % of CIN III progress to invasive carcinoma within 2-10 years?
A
10%
22
Q
What % of CIN III will regress spontaneously?
A
30%
23
Q
How long does progression from CIN I to III take approximately?
A
7 years
24
Q
What is invasive cervical cancer?
A
Where there is breach of the epithelial basement membrane at any point
25
What can invasive cervical cancer be divided into?
- Micro-invasive carcinoma
| - Invasive carcinoma
26
What is micro-invasive carcinoma of the cervix?
Deepest invasive element is <5mm from the surface of the epithelium
27
What is invasive carcinoma of the cervix?
Deepest invasive element is >5mm from the surface of the epithelium or >7mm wide
28
What does invasive carcinoma of the cervix require in terms of assessment?
Formal staging
29
What is the most important risk factor for cervical cancer?
Presence of HPV infection
30
What % of cervical tumours have HPV infection involved?
99%
31
What are the most high risk types of HPV in terms of cervical cancer?
16 and 18
32
What % of cervical cancer have HPV 16/18 involved?
70%
33
What are some other risk factors for cervical cancer?
- Heterosexual women
- Women with multiple sexual partners
- Partners of promiscuous males
- Smoking
- Lower social class
- Immunosuppression
- Long term use of OCP
- Non-attendance at cervical screening programme
34
What is the aim of the cervical screening programme?
To detect CIN in the asymptomatic population to reduce mortality and morbidity
35
How is cervical cancer screening performed?
Insert speculum to view the squamocolumnar junction of the cervix and rotate brush against it to take cells for liquid based cytology
36
How are the cells taken on cervical cancer screening analysed?
Look for abnormalities of the nucleus and other aspects of cell morphology
37
How can the results of cervical cancer screening be classified?
- Negative
- Inadequate
- Borderline
- Mild dyskaryosis
- Moderate dyskaryosis
- Severe dyskaryosis
- Glandular neoplasia
38
What % of cervical cancer screening tests are negative?
94%
39
What can cause an inadequate cervical cancer screening result?
- Insufficient materials sampled
- Unlabelled specimens
- Inadequate fixation/poor spreading on the material
40
What is a borderline cervical cancer screening result?
Cells with abnormal nuclei but cannot say for certain if they display dyskaryosis
41
What does mild dyskaryosis usually equate to?
CIN I
42
What does moderate dyskaryosis usually equate to?
CIN II
43
What doe severe dyskaryosis usually equate to?
CIN III
44
What percent of cervical smears show glandular neoplasia?
0.1%
45
What does glandular neoplasia indicate?
Abnormalities of glandular cells suggestive of adenocarcinoma in situ/of cervix/ endometrial adenocarcinoma or other organ
46
How should a negative cervical screening result be managed?
- Investigate any incidental findings
- Ensure patient is informed
- Recall as appropriate for age and previous history
47
How should inadequate cervical screening results be managed?
- Repeat sample as soon as possible
| - If persistent advise for colposcopy
48
How should borderline and mild dyskaryosis results be managed?
- Test for HPV
49
If HPV test for borderline or mild cervical screening results is negative, how should this be managed?
Return to normal recall
50
If HPV test for borderline or mild cervical screening results is positive how should this be managed?
Refer for colposcopy
51
How should moderate or severe dyskaryosis cervical screening result be handled?
Refer for colposcopy
52
What will women that have been treated for abnormal cervical screening result be followed up?
'Test of cure' 6 months after treatment
53
What is involved in a test for following abnormal cervical screening?
- HPV test
| - Cytology of smear
54
What happens if 6 months recall HPV test is positive or there is moderate/severe dyskaryosis?
Back to colposcopy
55
What happens if 6 months recall HPV is negative?
Normal recall
56
What screening frequency is given following a CIN I?
- Repeat at 6 months
- Repeat at 12 months
- Yearly for 2 years
57
What screening frequency is given following a CIN II and III?
- Repeat at 6 months
- Repeat at 12 months
- Yearly for 8 years
58
What screening frequency is given following invasive disease?
- Repeat at 3 months
- Repeat at 6 months
- 6 monthly for 5 years
59
How are most cases of cervical cancer detected?
By screening
60
What are the symptoms of CIN and micro-invasive disease?
None
61
What are the symptoms of early stage invasive cervical cancer?
- Abnormal vaginal bleeding
- Vaginal discharge
- Vaginal discomfort/urinary symptoms
62
What sort of bleeding can occur in early invasive cervical cancer?
- Spontaneous
- Post-coital
- After micturition or defecation
63
How can vaginal discharge due to early invasive cervical cancer vary?
- In volume
| - Intermittent or continuous
64
What are the symptoms of late cervical cancer?
- Painless haematuria
- Chronic urinary frequency
- Painless fresh rectal bleeding
- Altered bowel habit
65
What are the signs of early stage cervical cancer?
Usually relatively normal
66
What are the potential examination findings of cervical cancer?
- White or red patches on the cervix
- Rectal examination may reveal mass or bleeding
- Bimanual palpation may show pelvic mass
- Leg oedema may develop
- Hepatomegaly
67
Why can cervical cancer lead to white or red patches on the cervix?
Due to erosion, ulcer or tumour
68
Why may rectal examination show mass or bleeding in cervical cancer?
Due to erosion
69
Why may bimanual examination show a mass in cervical cancer?
Due to pelvic spread
70
Why may leg oedema develop in cervical cancer?
Due to lymphatic spread or vascular obstruction
71
Why may cervical cancer cause hepatomegaly?
If liver mets
72
When should a 2WW referral be made for cervical cancer?
- Appearance consistent with cervical cancer
73
Is a smear test required before referral for cervical cancer?
No
74
Is a previous negative smear test a reason to delay referral for potential cervical cancer?
No
75
What are the differentials for cervical cancer?
- Cervicitis
- Dysfunctional uterine bleeding
- Cervical erosion (ectropion)
- PID
- Endometrial cancer
- Side-effects of IUCD use
- Endometrial hyperplasia
- Fibroids
- Atrophic vaginitis
76
What examinations should be performed for symptoms suspicious of cervical cancer?
- Pelvic examination
| - Speculum
77
What is the main investigation for suspected cervical cancer?
Colposcopy
78
What does colposcopy allow for?
Examination of the entire cervix and the transformation zone
79
What happens in colposcopy for cervical cancer?
- Cervix cleaned with acetic acid
- Inspection
- Biopsy
- Treatment if necessary
80
What are the key diagnostic criteria for cervical cancer on colposcopy?
- Abnormal vasculature
- White change with acetic acid
- Obvious exophytic lesions
81
What other investigations may be undertaken for cervical cancer?
- FBC, RFT, LFT
- CT CAP with contrast
- PET
- Examination under anaesthesia
- HPV testing
82
What is a CT CAP used for in cervical cancer?
Assessing for mets
83
What is a PET scan used for in cervical cancer?
Staging
84
What examinations can be done under anaesthesia for cervical cancer?
- Abdominal
- Vaginal
- Rectal
- Colposcopy
- Hysteroscopy
- Cystoscopy
- Sigmoidoscopy
- Biopsy
85
What staging system is most commonly used for cervical cancer?
FIGO
86
What is Stage 0 cervical cancer?
No evidence of primary tumour - so not cervical cancer
87
What is Stage Tisb cervical cancer?
Carcinoma in-situ (pre-invasive)
88
What is Stage I cervical cancer?
Carcinoma confined to the cervix
89
What is Ia cervical cancer?
Invasive carcinoma diagnosed only by microscopy
90
What is Ib cervical cancer?
Clinically visible lesions confined to the cervix
91
What is Stage II cervical cancer?
Tumour invades beyond the cervix but not the pelvic muscles or ligaments or lower vagina
92
What is IIa cervical cancer?
Cancer has spread into the top of the vagina
93
What is IIb cervical cancer?
Tumour has gone above the cervix
94
What is Stage III cervical cancer?
Cancer has spread into the surrounding pelvic structures (but not organs) or lower vagina
95
What is IIIa cervical cancer?
Cancer in lower vagina but not pelvic wall
96
What is IIIb cervical cancer?
Tumour is in the pelvic wall or blocking the ureter
97
What is Stage IV cervical cancer?
Spread to other organs of the body e.g. rectum
98
What is IVa cervical cancer?
Spread to nearby organs e.g. rectum
99
What is IVb cervical cancer?
Spread to distant organs e.g. lungs
100
What is the most important issue to consider when treating cervical cancer?
Potential to spare fertility as many patients are young
101
What options are available for treating cervical cancer?
- Surgery
- Chemotherapy
- Radiotherapy
102
What are the main treatments for CIN I?
Follow-up or cryotherapy
103
What is the treatment for CIN II or III?
- Superficial excision with loop diathemy if confined to ectocervix
- Loop biopsy for CIN III in cervical canal
104
What is the treatment for Ia1 cervical cancer?
Conisation with free margins or simple hysterectomy depending on age and fertility choices
105
What may be required if pathology shows positive margins after local excision of Ia1 cervical cancer?
Hysterectomy or chemoradiation
106
What is the most commonly used chemotherapy agent in cervical cancer?
Cisplatin
107
What are the treatment options for Ia2 cervical cancer?
Local excision or extra-fascial hysterectomy
108
What is the advantage of local excision over hysterectomy for micro-invasive cervical cancer?
It preserves fertility
109
What would be considered early stage cervical cancer?
Ib1 - IIa
110
What is the treatment for an early stage cervical cancer <2cm where fertility is to be preserved if cancer Ia2-Ib1?
Radical trachelectomy and lymphadenectomy
111
What is the treatment for early stage cervical cancer >2cm and the patient is suitable for surgery?
Radical hysterectomy and lymphadenectomy
112
What does radical hysterectomy include removal of?
Parametrial tissue and upper 1/3 of vagina
113
What may be required for treatment of >2cm early stage cervical cancer if pathology shows positive nodes, involvement of the parametrium or position margins?
Post-op chemotherapy
114
What is the preferred treatment for >4cm early stage cervical cancer?
Chemoradiation
115
What treatment is given for early stage cervical cancer if tumour is between 2 and 4cm and patient is not suitable for surgery?
Chemoradiation
116
What is locally advanced cervical cancer?
IIb - IVa
117
What is the treatment for locally advanced cervical cancer?
Chemoradiation
118
What is metastatic cervical cancer treated with?
Combination therapy
119
What can be given if distant cervical cancer mets are isolated and amenable to local treatment?
- Adjunctive surgery
- Local ablative therapies
- Adjunctive radiation
120
What options are available if combination therapy for advanced or metastatic cervical cancer is not effective?
- Single-agent chemotherapy
- Clinical trial
- Supportive care
121
If a pregnant woman has cervical cancer and wants to keep her baby how should the pregnancy be dealt with?
MDT care and delivery after 35 weeks
122
What treatment options are not safe in pregnancy for cervical cancer?
- Radiotherapy
| - Surgery is best avoided
123
When is chemotherapy for cervical cancer safe in pregnancy?
Appears to be in 2nd and 3rd trimester but little data available
124
What features of cervical cancer indicate a poorer prognosis?
- Adenocarcinoma
- Lymph node involvement
- Advanced clinical stage
- LArge primary tumour
- Early recurrence
125
What is the 5 year survival rate for Stage 1a cervical cancer?
100%
126
What is the 5 year survival rate for Stage 4 cervical cancer?
10-20%
127
Overall what % of people with cervical cancer survive for 10 years or more?
63%
