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Y5 Gynae & Obstetrics > Cervical cancer > Flashcards

Cervical cancer Flashcards

1
Q

What are the low risk HPV strains

A

6, 11

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2
Q

What are the high risk HPV strains

A

16, 18

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3
Q

Where do cervical cancers usually occur?

A

In the TRANSITION ZONE (between original squamocolumnar junction and current SCJ)

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4
Q

What can HPV cause?

A

Disordered maturity

Cervical Intraepithelial neoplasia (CIN)

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5
Q

What are the high grade and low grade CIN stages?

A

CIN 1 is low grade

CIN 2,3 are high grade

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6
Q

What occurs to CIN1?

A

Spontaneously regreess

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7
Q

What occurs to CIN2,3?

A

Require treatment

20% progress to cancer

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8
Q

How is cervical cytology performed?

A

Liquid based cytology
Sample cells from TZ and place brush head in a fixative
View under microscope
Squamous cells will be at different stages of maturity (dyskariosis)

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9
Q

What is the statistical strength of HPV screening?

A

Strong negative predictive value

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10
Q

What do you do if HPV screening is positive?

A

Refer to colposcopy

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11
Q

What occurs in colposcopy?

A

Speculum
IN situ microscopy
Application of solutions
Biopsy

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12
Q

What solutions are applied in colposcopy?

A

Acetic acid

Iodine

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13
Q

What will acetic acid show?

A

Areas of increased cell turnover appear white including CIN

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14
Q

What does iodine show in CIN?

A

Areas of CIN lack glycogen, so fail to turn brown

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15
Q

What does colposcopy allow you to classify?

A

CIN as low/high grade

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16
Q

What do you do after colposcopy for low grade CIN?

A

Subsequent colposcopy and cytology in 6 months

17
Q

What do you do after colposcopy for high grade CIN?

A

treat in clinic on same visit (used to be done)

NOW- TAKE BIOPSY AND CALL BACK WITH RESULTS

18
Q

How do you treat high grade CIN?

A
  • LLETZ (loop diathermy)

- Cone biopsy

19
Q

What is Gardasil?

A

quadrivalent vaccine

For 6,11,16,18

20
Q

What is classic presentation for cervical cancer?

A

ABNORMAL BLEDING

  • post coital bleed
  • intermenstrual bleed
  • postmenopausal bleed
21
Q

What is presentation in advanced cervical cancer=

A

Pain
Incontinece (vescicovaginal fistula)
Renal failure (ureteric block)
Anaemia

22
Q

What do you see on speculum for cervical cancer?

A

A cervical mass

It bleeds on contact

23
Q

Explain staging of cervical cancer

A
  1. confined to cervix
  2. Involved vagina (top 2/3) or parametrium
  3. involved vagina (incl lower 1/3 or pelvic side wall)
  4. involves mucosa of bladder / rectum
24
Q

What is the difference between 1A and 1B stage?

A

1A: microscopic disease
1B: macroscopic clinical lesion

25
Q

How do you treat 1A?

A

Excision with clear margin

26
Q

How do you treat 1B?

A

If confined to cervix (1B):

  • Wertheim’s hysterectomy
  • Radical trachelectomy + node dissection if fertility sparing required
  • OR radiotherapy (same outcome)

If belong

27
Q

What is - Wertheim’s hysterectomy

A

Radical hysterectomy with bilateral pelvic node dissection

28
Q

How do you treat stages 2-4 cervical cancer?

A

Radiotherapy (external beam OR internal)

29
Q

What are most vulval cancers?

A

Squamous cell carcinoma

30
Q

What are SCC of vulva associated with sometimes?

A

HPV

Lichen sclerosus

31
Q

What does vulval SCC present with?

A

Lump/ulcer
bleeding and discharge
painful or painless\

32
Q

How do you treat vulval SCC?

A

Vulval excitsion

Sentinel lymph node biopsy

33
Q

What is the pathway from smear onwards?

A

HPV smear > if+> cytology >if+> colposcopy

34
Q

How long after LLETZ do you book someone in to see you again?

A

6 month review

“test for cure” appointment

35
Q

What age ranges is HPV screening done for?

A

25-64

from 25 to 49 every 3 years
from 50 to 65 every 5

Y5 Gynae & Obstetrics (34 decks)

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