Cervical cancer Flashcards
What are the low risk HPV strains
6, 11
What are the high risk HPV strains
16, 18
Where do cervical cancers usually occur?
In the TRANSITION ZONE (between original squamocolumnar junction and current SCJ)
What can HPV cause?
Disordered maturity
Cervical Intraepithelial neoplasia (CIN)
What are the high grade and low grade CIN stages?
CIN 1 is low grade
CIN 2,3 are high grade
What occurs to CIN1?
Spontaneously regreess
What occurs to CIN2,3?
Require treatment
20% progress to cancer
How is cervical cytology performed?
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)
What is the statistical strength of HPV screening?
Strong negative predictive value
What do you do if HPV screening is positive?
Refer to colposcopy
What occurs in colposcopy?
Speculum
IN situ microscopy
Application of solutions
Biopsy
What solutions are applied in colposcopy?
Acetic acid
Iodine
What will acetic acid show?
Areas of increased cell turnover appear white including CIN
What does iodine show in CIN?
Areas of CIN lack glycogen, so fail to turn brown
What does colposcopy allow you to classify?
CIN as low/high grade
What do you do after colposcopy for low grade CIN?
Subsequent colposcopy and cytology in 6 months
What do you do after colposcopy for high grade CIN?
treat in clinic on same visit (used to be done)
NOW- TAKE BIOPSY AND CALL BACK WITH RESULTS
How do you treat high grade CIN?
- LLETZ (loop diathermy)
- Cone biopsy
What is Gardasil?
quadrivalent vaccine
For 6,11,16,18
What is classic presentation for cervical cancer?
ABNORMAL BLEDING
- post coital bleed
- intermenstrual bleed
- postmenopausal bleed
What is presentation in advanced cervical cancer=
Pain
Incontinece (vescicovaginal fistula)
Renal failure (ureteric block)
Anaemia
What do you see on speculum for cervical cancer?
A cervical mass
It bleeds on contact
Explain staging of cervical cancer
- confined to cervix
- Involved vagina (top 2/3) or parametrium
- involved vagina (incl lower 1/3 or pelvic side wall)
- involves mucosa of bladder / rectum
What is the difference between 1A and 1B stage?
1A: microscopic disease
1B: macroscopic clinical lesion
How do you treat 1A?
Excision with clear margin
How do you treat 1B?
If confined to cervix (1B):
- Wertheim’s hysterectomy
- Radical trachelectomy + node dissection if fertility sparing required
- OR radiotherapy (same outcome)
If belong
What is - Wertheim’s hysterectomy
Radical hysterectomy with bilateral pelvic node dissection
How do you treat stages 2-4 cervical cancer?
Radiotherapy (external beam OR internal)
What are most vulval cancers?
Squamous cell carcinoma
What are SCC of vulva associated with sometimes?
HPV
Lichen sclerosus
What does vulval SCC present with?
Lump/ulcer
bleeding and discharge
painful or painless\
How do you treat vulval SCC?
Vulval excitsion
Sentinel lymph node biopsy
What is the pathway from smear onwards?
HPV smear > if+> cytology >if+> colposcopy
How long after LLETZ do you book someone in to see you again?
6 month review
“test for cure” appointment
What age ranges is HPV screening done for?
25-64
from 25 to 49 every 3 years
from 50 to 65 every 5
