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Reproductive Health > Cervical Cancer > Flashcards

Cervical Cancer Flashcards

1
Q

Cervical cancer is the …. most common cancer in the UK

A

Third

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2
Q

What type of age distribution does it have?

A

Bimodal: 30-39 and the over 70s

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3
Q

What percentage of cervical cancer occurs in the developing world?

A

80%

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4
Q

2/3 are what type off cancer?

A

Squamous cell carcinoma

1/3 = adenocarcinoma

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5
Q

What risk factors are there?

A 
HPV
How long the HPV infection lasts 
Young age at first intercourse 
Multiple sexual partners 
Smoking 
Immunocompromised/ HIV
Long term COCP 
Non compliance with cervical screening 
Positive FH
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6
Q

What factors reduce risk?

A

HPV vaccination

Cervical screening compliance

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7
Q

What is the most important factor for developing cervical cancer?

A

HPV

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8
Q

How many serotypes of HPV are there?

A

Approx 100, 40 target the genital tract

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9
Q

What serotypes of HPV are the most high risk?

A

16, 18

Also 31,33,34,35,39,45,51,52,56,58,59,66,68

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10
Q

What low risk types of HPV are there?

A

6,11,42,43,44 - present in the form of warts

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11
Q

What is the mechanism by which HPV causes cervical cancer?

A

HPV 16,18 in particular produce proteins E6 and E7, which suppress the p53 tumour suppressor gene in keratinocytes

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12
Q

Will most women be infected by HPV at some time?

A

Yes
HPV infection common in late teens and early 20s
Infection last approx 8 months

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13
Q

Can vaccination prevent most cases of cervical carcinoma?

A

Yes

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14
Q

Describe the natural history of HPV infection

A

Cleared
Persistent
Causing cervical intraepithelial neoplasia (CIN)

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15
Q

What is cervical intraepithelial neoplasia (CIN)?

A

A premalignant condition (pre invasion)
Occurs at transformation zone
Can be asymptomatic
From CIN I to CIN III - depends on how much basement membrane is involved

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16
Q

Describe CIN I

A

Affects the lower basal third of cervical epithelium

Will regress to normal in 60% within 2 years

17
Q

What do CIN II and CIN III affect?

A

<2/3 and >2/3 or full thickness of epithelium

Less illegal to regress and significant number develop into invasive squamous carcinoma of cervix

18
Q

What features are associated with cervical cancer?

A

May be dented during routine cervical cancer screening
PCB
PMB
IMB
Features of advanced disease: heavy vaginal bleeding, ureteric obstruction, weight loss, bowel disturbance, vesicovaginal fistula, pain, lower limb oedema

19
Q

What percentage of those with cervical cancer have never had a smear?

A

50%

20
Q

Describe stage I

A

Tumours confined to the cervix
A - microinvasion
B - clinical lesion (macroscopic)

21
Q

Describe stage II

A

Has extended beyond cervix, but not pelvic side wall or lower 1/3 vagina
A - upper 1/3 vagina
B - parametrium

22
Q

Describe stage III

A

Pelvic spread - reaches side wall of low 1/3 vagina
A- lower 1/3 vagina or hydronephrosis
B - extends to pelvic side wall or hydronephrosis (blocking’s one or both of tubes that drain kidney)

23
Q

Describe stage IV

A

Distant spread
A - adjacent organs e.g bladder, bowel
B - distant

24
Q

What is 5 year survival for the stages?

A 
SIA = 96-99%
SIB = 80-90%
SII = 65-69%
SIII = 40-43%
SIV = 15-20%
25
Q

What is the management for IA tumours?

A

Gold standard: hysterectomy +/- LN clearance
For patients wanting to maintain fertility: cone biopsy with negative margins can be performed - close follow up, once family complete: hysterectomy

26
Q

How are clinical lesions IB-2A managed?

A

Wertheim’s radical hysterectomy

Or chemoradiotherapy

27
Q

How are clinical lesions beyond 2A managed?

A

Chemoradiotherapy

28
Q

What complications of surgery are there?

A 
Infection 
VTE
Haemorrhage 
Vesicovaginal fistula
Bladder dysfunction 
Lymphocyst formation 
Short vagina
29
Q

What complications of RT are there?

A

Vaginal dryness, stenosis
Radiation cystitis
Radiation proctitis
Loss of ovarian function

30
Q

What cells make up the endocervix and ectocervix?

A

Endocervix - closer to the body of the uterus, made up of columnar epithelial cells that produce mucus

Ectocervix - closer to the vaginal, made up of mature squamous epithelium

31
Q

What is it called where the cells of the endocervix and ectocervix meet?

A

Transformation zone

Where subcolumnar reserve cells multiply and transform into immature squamous epithelium in a process called metaplasia

32
Q

Where does CIN typically start?

A

The basal layer of the transformation zone - typically in the immature squamous epithelium

33
Q

Is cervical adenocarcinoma associated with HPV?

A

Yes

34
Q

Where does it typically metastasise to?

A

Lung
Liver
Bone
Bowel

Reproductive Health (70 decks)

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