Cervical cancer Flashcards
what is the most common cause of cervical cancer?
human papilloma virus
what is the purpose of screening for cervical cancer?
detection and treatment of pre-invasive changes which are asymptomatic to prevent cancer
what types of HBV virus is responsible for most cervical cancers?
HBV 16 and 17
what is a squamous intraepithelial lesion?
a group of abnormal cells detectable on smear
what are abnormal cells in the cervix detected by biopsy and histology classified as?
cervical intraepithelial neoplasia
what HPV virus causes genital warts?
HPV 6, 11, 42, 44
what technique is used for a pap smear test to identify HPV infection?
liquid based cytology
if someones cytology shows low grade dyskaryosis what is the next step?
refer to colposcopy
this is used to examine the cervix to identify if there is malignant cells and extent of the cancer
when are smear tests carried out?
from 25-64 years
every 5 years
what are the treatment options for pre-cancerous cervical cancer?
excision - LLETZ: lazer loop excision of the transformation zone
ablation - thermal or laser ablation
when are girls immunised against HPV ?
from the age of 12
what HPV vaccine will girls get who were born after 1st sep 1990?
sep 2020?
sep 2014?
after 1990 = bivalent vaccine (HPV 16,18)
2012 = quadrivalent vaccine (HPV 16,18,6,11)
2014 = 2 dose regime
how is cytology carried out?
cells are scraped from the transitional zone of the cervix
look for abnormal cells and are able to indicate women with squamous intraepithelial lesions (pre cancerous cells)
what is dyskaryosis and from what investigation technique can you identify if there is dyskaryosis present?
abnormal cells that can be viewed by cytology (pap smear)
what are kilocytes and what do they indicate?
cells with a wrinkled nucleus and perinuclear halo - multinucleated
indicate HPV infection
what cell type found on a smear test indicates a HPV infection?
kilocytes
what is the recurrence rates of cervical cancer?
5% in 3-5 years
what type of cell lines the endocervix and exocervix?
endocervix = columnar epithelium (glandular) ectocervix = squamous epithelium
what part of the cervix does the HPV vaccine invade and why?
transitional zone because it is unstable due to the transition of cells from squamous to columnar
what are the risk factors for cervical cancer?
HPV smoking early age of sexually active (<18 yrs) multiple sexual partners HIV immunosuppression age (44-55)
what is the presentation of cervical cancer?
majority picked up on screening which are asymptomatic
vaginal bleeding mucoid/purulent discharge post-coital bleeding dyspareunia cervical mass pelvic/back pain
how is cervical cancer diagnosed?
speculum examination
colposcopy
biopsy
what are the treatment options for cervical cancer?
stage 1: type 3 excision of cervical transitional zone (conization) or hysterectomy
stage 2: radical hysterectomy or chemo-radiatiotherapy
stage 3: chemo-radiotherapy
what is the 5 year survival rates for cervical cancer?
stage 1 - 92%
stage 2 and 3 - 56%
stage 4 - 17%
where can metastatic cervical cancer spread to?
lymphatic - pelvic nodes
blood - liver, lung and bone
how is cervical cancer screening carried out?
Pap smear - scrape off cervical cells at the transformation zone for cytology. every 5 years 25-64 yrs
if HPV present refer patient for colposcopy
if pre-cancerous cells - LLETZ
if cancer - biopsy and further imaging for staging
how does HPV cause cervical intraepithelial neoplasia?
HPV viral DNA integrates into host genome
causes over expression of E6 and E7 proteins
this causes deregulation of the host cell cycle
at what part of the cervix is cervical cancer most commonly found?
squamocolumnar junction at the transformation zone
