Cervical Cancer Flashcards
Cervical cancer is the …. most common cancer in the UK
Third
What type of age distribution does it have?
Bimodal: 30-39 and the over 70s
What percentage of cervical cancer occurs in the developing world?
80%
2/3 are what type off cancer?
Squamous cell carcinoma
1/3 = adenocarcinoma
What risk factors are there?
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
What factors reduce risk?
HPV vaccination
Cervical screening compliance
What is the most important factor for developing cervical cancer?
HPV
How many serotypes of HPV are there?
Approx 100, 40 target the genital tract
What serotypes of HPV are the most high risk?
16, 18
Also 31,33,34,35,39,45,51,52,56,58,59,66,68
What low risk types of HPV are there?
6,11,42,43,44 - present in the form of warts
What is the mechanism by which HPV causes cervical cancer?
HPV 16,18 in particular produce proteins E6 and E7, which suppress the p53 tumour suppressor gene in keratinocytes
Will most women be infected by HPV at some time?
Yes
HPV infection common in late teens and early 20s
Infection last approx 8 months
Can vaccination prevent most cases of cervical carcinoma?
Yes
Describe the natural history of HPV infection
Cleared
Persistent
Causing cervical intraepithelial neoplasia (CIN)
What is cervical intraepithelial neoplasia (CIN)?
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
Describe CIN I
Affects the lower basal third of cervical epithelium
Will regress to normal in 60% within 2 years
What do CIN II and CIN III affect?
<2/3 and >2/3 or full thickness of epithelium
Less illegal to regress and significant number develop into invasive squamous carcinoma of cervix
What features are associated with cervical cancer?
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
What percentage of those with cervical cancer have never had a smear?
50%
Describe stage I
Tumours confined to the cervix
A - microinvasion
B - clinical lesion (macroscopic)
Describe stage II
Has extended beyond cervix, but not pelvic side wall or lower 1/3 vagina
A - upper 1/3 vagina
B - parametrium
Describe stage III
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)
Describe stage IV
Distant spread
A - adjacent organs e.g bladder, bowel
B - distant
What is 5 year survival for the stages?
SIA = 96-99% SIB = 80-90% SII = 65-69% SIII = 40-43% SIV = 15-20%
What is the management for IA tumours?
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
How are clinical lesions IB-2A managed?
Wertheim’s radical hysterectomy
Or chemoradiotherapy
How are clinical lesions beyond 2A managed?
Chemoradiotherapy
What complications of surgery are there?
Infection VTE Haemorrhage Vesicovaginal fistula Bladder dysfunction Lymphocyst formation Short vagina
What complications of RT are there?
Vaginal dryness, stenosis
Radiation cystitis
Radiation proctitis
Loss of ovarian function
What cells make up the endocervix and ectocervix?
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
What is it called where the cells of the endocervix and ectocervix meet?
Transformation zone
Where subcolumnar reserve cells multiply and transform into immature squamous epithelium in a process called metaplasia
Where does CIN typically start?
The basal layer of the transformation zone - typically in the immature squamous epithelium
Is cervical adenocarcinoma associated with HPV?
Yes
Where does it typically metastasise to?
Lung
Liver
Bone
Bowel
