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Cervical Cancer (AAG) Flashcards

1
Q

In the UK, how common is cervical cancer compared to other cancers?

A

7th most common female cancer

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2
Q

What % of cervical cancer cases worldwide occur in the developing world?

A

80%

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3
Q

What is the average age of presentation of cervical cancer?

A

35-44 years

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4
Q

What is the decline in incidence of cervical cancer due to?

A

The introduction of screening programmes based on cytological cervical smear assessment

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5
Q

How does invasive cervical cancer most common progress?

A

From infection by human papilloma virus (HPV) to cervical intraepithelial neoplasia (CIN), and on to invasive disease

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6
Q

What is CIN?

A

A cytological diagnosis

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7
Q

What does CIN describe?

A

The involvement of the epidermis

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8
Q

What is CIN 1?

A

The involvement of the lower 1/3 of the epithelium

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9
Q

What is CIN 2?

A

Involvement of lower 2/3 of epithelium

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10
Q

What is CIN 3?

A

Involvement of all layers of epithelium

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11
Q

When does cervical cancer develop (from CIN)?

A

When the disease breaches the epithelial basement membrane and invades the cervical stroma

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12
Q

What kind of cancer are the majority of cervical cancers?

A

Squamous cell

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13
Q

What is the less common type of cervical cancer?

A

Adenocarcinoma

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14
Q

What % of cases of cervical cancer are adenocarcinomas?

A

15%

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15
Q

Where do cervical adenocarcinomas develop from?

A

The endocervical epithelium

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16
Q

Who do cervical adenocarcinomas most commonly affect?

A

Women under 40

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17
Q

What is the most significant causative factor of cervical cancer?

A

HPV

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18
Q

Which strains of HPV convey the greatest risk of cervical cancer?

A

HPV 16 and 18

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19
Q

What are the other risk factors for cervical cancer?

A
  • High number of sexual partners
  • Early age at first intercourse
  • Low socioeconomic status
  • Non-barrier forms of contraception
  • Cigarette smoking
  • Prolonged use of combined oral contraceptive pill
  • Multi-parity
  • Immunocompromised state
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20
Q

What are the different vaccinations against HPV?

A
  • Cervarix

- Gardasil

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21
Q

What does Cervarix protect against?

A

HPV 16 and 18

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22
Q

What does Gardasil protect against?

A

HPV 6, 1,1, 16, and 18

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23
Q

What is the advantage of Gardasil over Cervarix?

A

It protects against many cases of genital warts as well as cervical cancer

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24
Q

Who is offered Cervarix?

A

All 12 and 13 year old girls in the UK

i think this might have changed? idk its from a book but i think they have the warts one now, look it up if you care

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25
What stages of cervical cancer development are asymptomatic?
CIN and microinvasive disease
26
How does early stage invasive cervical cancer present?
- Post-coital bleeding - Intermenstrual bleeding - Postmenopausal bleeding - Offensive vaginal discharge
27
Is pain common in early stage invasive cervical cancer?
No
28
What causes symptoms in later stage cervical cancer?
Involvement of the ureters, bladder, rectum, and nerves
29
What can involvement of the ureters and bladder in late stages of cervical cancer lead to?
- Uraemia | - Haematuria
30
What can involvement of the rectum in late stages of cervical cancer lead to?
- Rectal bleeding
31
What can involvement of nerves in late stages of cervical cancer lead to?
- Back pain - Referred pain in legs - Deep lateral pain (?)
32
What can mass effects of a bulky tumour in cervical cancer lead to?
- Increased urinary frequency | - Altered bowel habit
33
What is found on examination in CIN and micro-invasive disease?
Bimanual palpation and speculum examination of the cervix often appears normal
34
When might a palpable cervical mass be apparent in cervical cancer?
Only in invasive disease
35
What investigation is performed to visualise the cervix in cervical cancer?
Colposcopy
36
How are the features of pre-invasive cervical cancer identified on colposcopy?
Acetic acid is applied to the cervix
37
What are the features of cervical cancer when acetic acid is applied?
- Presence of leukoplakia (white epithelium) - Mosaic structure - Punctation on the cervix
38
What is suggestive of invasive cervical cancer on colposcopy with acetic acid?
Abnormal vascularity
39
What can be obtained during colposcopy?
A punch or loop biopsy
40
What is the purpose of a punch or loop biopsy in cervical cancer?
Allows for histological examination and confirmation of diagnosis
41
What investigation do patients with symptomatic cervical cancer require?
Examination under anaesthetic
42
What is the purpose of examination under anaesthetic in patients with symptomatic cervical cancer?
Establish extent of disease
43
How is cervical cancer staged?
Using FIGO system
44
What is different about the FIGO system of cervical cancer staging?
The divisions are histological, and do not include lymph node involvement
45
What is stage 0 in cervical cancer?
Pre-invasive disease, CIN 1-3
46
What is stage 1a1 cervical cancer?
Stromal invasion only, with a maximum depth of 3mm and no wider than 7mm
47
What is stage 1a2 cervical cancer?
Stromal invasion only, with a depth >3mm but <5mm and no wider than 7mm
48
What is stage 1b1 cervical cancer?
Clinical lesion confined to cervix, greater than stage 1a and less than 4cm in size
49
What is stage 1b2 cervical cancer?
Clinical lesion confined to cervix but greater than 4cm in size
50
What is stage 2a cervical cancer?
Tumour extends beyond cervix, no obvious parametrial involvement. Involvement of up to the upper two-thirds of vagina
51
What is stage 2b cervical cancer?
Obvious parametrial involvement but not into the pelvic side wall
52
What is stage 3a cervical cancer?
Tumour not extending into the pelvic side wall but involves lower third of vagina
53
What is stage 3b cervical cancer?
Extension into the pelvic side wall, or hydronephrosis, or non-functioning kidney
54
What is stage 4a cervical cancer?
Tumour spread to involve adjacent organs outside of the true pelvis
55
What is stage 4b cervical cancer?
Distant metastasis
56
What investigation might be performed in cervical cancer when there is suspicion of adjacent organ involvement?
Cystoscopy and sigmoidoscopy
57
Why might a CT or MRI scan be done in cervical cancer?
To assess tumour bulk and lymphadenopathy
58
What does the national cervical cancer screening programme offer?
A cervical smear every 3 years to women aged 25-30 years, and every 5 years to women aged 50-64 years
59
How do cervical smears work?
They use cytology to detect abnormal cells
60
What is the purpose of cervical smears?
To prompt intervention to prevent invasive cancer developing
61
What is optimum treatment for cervical cancer determined by?
- Stage of disease - Age and general health of woman - Plans for future fertility
62
What is the treatment for CIN 2/3 confined to the visible ectocervix?
Local excision using loop diathermy
63
What is the treatment for CIN 3 with disease extending into the cervical canal?
Loop biopsy
64
What is the treatment for microinvasive cervical cancer?
Simple hysterectomy
65
What is the treatment for stage 1b or 2 cervical cancers?
Radical hysterectomy with pelvic lymphadenectomy or pelvic radiotherapy
66
What is the treatment for stage 2b or 3 cervical cancers?
Pelvic radiotherapy, and if curative intent, chemoradiotherapy with cisplatin as radiation sensitiser
67
What is the treatment for stage 4 and recurrent disease?
Chemotherapy, with radiotherapy at specific sites of metastasis
68
Does chemotherapy alone have a role in the adjuvant treatment of cervical cancer?
No
69
What follow up is provided after treatment for cervical cancer?
Patients are reviewed with cervical smears and clinical examination
70
When are patients with CIN 1 reviewed after treatment?
6 months, 12 months, and then yearly for 2 years
71
When are patients with CIN2/3 reviewed after treatment?
6 months, 12 months, then yearly for 8 years
72
When are patients with invasive disease reviewed after treatment?
3 months, 6 months, then every 6 months for 5 years
73
What factors are associated with poor prognosis in cervical cancer?
- Adenocarcinoma - Lymph node involvement - Advanced clinical stage - Large primary tumour - Early recurrence
74
At what point is relapse of cervical cancer unusual?
After 5 years

Z - Cancer Care Old (28 decks)

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