Cervical cancer Flashcards
What puts you at risk of acquiring HPV infection?
- Multiple sexual partners
- Early age at first intercourse infection
- Older age of first partner - they’re more likely to have HPV infection as they are older
- Cigarette smoking
Why are you more at risk of HPV infection if you have sex at a young age?
Due to immaturity of the cervix and so the transformation zone is more susceptible to HPV infection
Cigarette smoking and HPV
- Smoking affects cell mediated immunity
- Nicotine is detected in cervical mucus
Cervical cancer has 2 peaks of incidence in women. What ages are these peaks?
One in younger women and then again in older women (70-80s) who may not have benefited from screening (only introduced in 1980s)
Deprivation and cervical cancer
See cervical cancer more in deprived women:
- Less likely to access screening
- More likely to smoke cigarettes
- Or other contributing factors like nutrition etc
This link to deprivation has been lost due to high uptake of HPV vaccine in school age children
Cervical cancer red flag symptoms
- Abnormal vaginal bleeding i.e Post coital bleeding, inter-menstrual bleeding, PMB
- Discharge? Sometimes woman describe bleeding as discharge as it can be brown and smell. However this can be the case if it is bleeding or a necrotic tumour
- (Pain) - not a common presentation - pain would be associated with advanced cancer i.e spread out to pelvic side walls (get neuropathic pain) or if there is obstruction of ureters and get back pain
How is cervical cancer diagnosed?
- Clinical - examination
- Screen detected - asymptomatic patient attends for screening and cancer is detected on examination or smear test comes back as high grade
- Biopsy
Look
If a patient has symptoms and attends their GP and the GP decides to take a smear test because they haven’t had one then this is a clinical cancer
Not a result of the screening programme
Look
Remember screening aims to detect pre-cancerous disease NOT cancer
How can you differentiate between Cervical intraepithelial neoplasia (CIN) and cancer using histology?
Tumour cells from the epithelium invade into the underlying stroma if cancerous
What are the 2 types of cervical cancer?
- Majority squamous carcinoma (80%)
- Adenocarcinoma (endocervical) rising in relative incidence
Describe stage 1A of cervical cancer
- Invasive cancer identified only microscopically. There is nothing clinical to see in this stage.
- 1a1 is a small invasion 1a2 is deeper
Describe stage 1B of cervical cancer
Clinical tumours confined to the cervix
Most of the cancers detected in young woman are of which stages?
Stage 1A or B
Local spread of cervical cancer
- Stage 2: Vagina (upper 2/3)
- Stage 3: lower vagina, pelvis
- Stage 4 bladder, rectum
Where does cervical cancer metastasise to?
Metastases is not as common in cervical cancer, however, if it does metastasie it spreads via:
- Lymphatics – pelvic nodes
- Blood – liver, lungs, bone
What imaging is used to stage cervical cancer? (2)
- PET-CT
- MRI
Do both usually
Treatment of cervical cancer
- Stage 1a - Excision of the cervical Transformation Zone or hysterectomy (if don’t need/want to preserve sexual function)
- Stage 1a or small stage 2 - radical hysterectomy (preserves ovaries for pre-menopausal women) or chemo-radiotherapy
- Advanced stages - chemo-radiotherapy
What is removed in a radical hysterecomy?
- Removal of: Uterus, cervix, upper vagina, Parametria (connective tissue around the cervix) and Pelvic nodes
- Preserves ovaries
- Done laparoscopically
Which is more successful - hysterectomy or chemo-radiotherapy?
Both have similar success rate so it depends on:
- Patient preference
- Their suitability for surgery
- Their menopausal status - do they want to preserve their sexual function?
What to remember!!
- Major cause of female death in developing world
- HPV is single most important cause
- Screening detects pre-invasive changes which are asymptomatic
- Cancer causes abnormal vaginal bleeding
- Surgery or combined chemoradiation
- Effective cure of early stage disease
