Cervical cancer Flashcards
what is the appearance of normal ectocervix
basal membrane with stromal cells
cells at top have large cytoplasm with small nucleus
what is the appearance of normal endocervix
lined by a single layer of glandular epithelium and row of nuclei
what area in the cervix is most likely to be affected by dysplastic change
transformation zone (squamocolumnar junction)
what are the neoplastic changes that occur in the cervix
CIN
cervical cancer - either squamous carcinoma or adenocarcinoma
what is CIN
cervical intraepithelial neoplasia
precursor lesion for cervical squamous carcinoma
list the risk factors for cervical neoplasia
HPV - particularly type 16 and 18
many sexual partners
sex from a young age - vulnerable SC junction
long term use of oral contraceptives
smoking
immunosuppression
lack of using barrier contraception methods
describe the histology findings of HPV in a smear
thickened papillomatous squamous epithelium with cytoplasmic vacuolation
presence of koilocytes - epithelial cells with darker, larger nuclei present
how long does it take for HPV infection to turn to high grade CIN
6 months - 3 years
how long does it take for high grade CIN to turn to invasive cancer
5-20 years
what is CIN
pre-invasive stage of cervical cancer
occurs at transformation zone, dysplasia of squamous cell
does CIN have any symptoms
no - this is why it requires detection through cervical smear
describe the histology of CIN
delay in maturation, more immature cells at top of epithelium
hyperchromasia
increased nucleocytoplasmic ratio
pleomorphism
what is CIN I
basal 1/3 occupied by abnormal epithelium
what is CIN II
abnormal cells extended to middle 1/3 of epithelium
what is CIN III
abnormal cells occupy full thickness of the epithelium, also called carcinoma in situ
when does CIN become cervical squamous carcinoma
when there is a breach /invasion of the stroma
what cervical cancer is more common, squamous cell or adenocarcinoma
squamous cell, makes up 75% of cervical tumours
what is the most common symptom of cervical cancer
abnormal uterine bleeding - either postmenopausal, post-coital or contact bleeding on examination
list the symptoms of a more advanced cervical cancer
pelvic pain
ureteric obstruction
haematuria/UTI
where might a cervical cancer locally invade
uterine body, vagina, bladder, uterus, rectum
how might a cervical cancer spread via lymphatics
pelvic and para-aortic nodes
how might a cervical cancer spread haematogenously
liver
bone
lung
what cell type does a CGIN originate from
from endocervical epithelium only
what is CGIN a precursor lesion for
cervical adenocarcinoma
what is harder to diagnose on a smear test CIN or CGIN
CGIN as less likely the region that is swabbed
what are the risk factors for cervical adenocarcinoma
later onset of sexual activity
smoking
HPV especially type 18
if patient has an abnormal smear test what happens next
if HPV positive repeat in 6 months
if mild dyskaryosis repeat in 6 months as can regress
if mod-severe dyskaryosis refer for colposcopy
if appearance is invasive, refer for colposcopy within 2 weeks
when do women receive smear tests
25-49 every 3 years
50-65 every 5 years
what level of CIN requires an excisional biopsy following colposcopy
CIN II or above
outline the management of low risk cervical cancer (stages IA-IA2)
cured through local excision, IA2 has a small risk of nodal involvement so pelvic lymphadenactomy may be offered
outline the management of moderate risk cervical cancer (IB-IIA)
radical hysterectomy + pelvic lymphadenectomy, oophrectomy can be performed by rarely spreads to the ovaries
radical radiotherapy + cisplastin are alternatives to surgery
outline the management of stages IIB-IV of cervical cancer
usually radical radiotherapy + cisplastin chemotherapy
what is a simple hysterectomy
removal of uterus, cervix and fallopian tubes
what is a radical hysterectomy
removal of uterus, cervix, fallopian tubes + top 2cm of the vagina and tissues around the cervix
list some side effects of radiotherapy targeted at the cervix
cystitis, diarrhoea, fibrosis causing vaginal stenosis and sexual dysfunction
what is brachytherapy
insertion of radiotherapy directly into the body specifically targeting the desired area, sparing the surrounding organs
