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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
Q

What stages of cervical cancer development are asymptomatic?

A

CIN and microinvasive disease

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26
Q

How does early stage invasive cervical cancer present?

A
  • Post-coital bleeding
  • Intermenstrual bleeding
  • Postmenopausal bleeding
  • Offensive vaginal discharge
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27
Q

Is pain common in early stage invasive cervical cancer?

A

No

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28
Q

What causes symptoms in later stage cervical cancer?

A

Involvement of the ureters, bladder, rectum, and nerves

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29
Q

What can involvement of the ureters and bladder in late stages of cervical cancer lead to?

A
  • Uraemia

- Haematuria

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30
Q

What can involvement of the rectum in late stages of cervical cancer lead to?

A
  • Rectal bleeding
31
Q

What can involvement of nerves in late stages of cervical cancer lead to?

A
  • Back pain
  • Referred pain in legs
  • Deep lateral pain (?)
32
Q

What can mass effects of a bulky tumour in cervical cancer lead to?

A
  • Increased urinary frequency

- Altered bowel habit

33
Q

What is found on examination in CIN and micro-invasive disease?

A

Bimanual palpation and speculum examination of the cervix often appears normal

34
Q

When might a palpable cervical mass be apparent in cervical cancer?

A

Only in invasive disease

35
Q

What investigation is performed to visualise the cervix in cervical cancer?

A

Colposcopy

36
Q

How are the features of pre-invasive cervical cancer identified on colposcopy?

A

Acetic acid is applied to the cervix

37
Q

What are the features of cervical cancer when acetic acid is applied?

A
  • Presence of leukoplakia (white epithelium)
  • Mosaic structure
  • Punctation on the cervix
38
Q

What is suggestive of invasive cervical cancer on colposcopy with acetic acid?

A

Abnormal vascularity

39
Q

What can be obtained during colposcopy?

A

A punch or loop biopsy

40
Q

What is the purpose of a punch or loop biopsy in cervical cancer?

A

Allows for histological examination and confirmation of diagnosis

41
Q

What investigation do patients with symptomatic cervical cancer require?

A

Examination under anaesthetic

42
Q

What is the purpose of examination under anaesthetic in patients with symptomatic cervical cancer?

A

Establish extent of disease

43
Q

How is cervical cancer staged?

A

Using FIGO system

44
Q

What is different about the FIGO system of cervical cancer staging?

A

The divisions are histological, and do not include lymph node involvement

45
Q

What is stage 0 in cervical cancer?

A

Pre-invasive disease, CIN 1-3

46
Q

What is stage 1a1 cervical cancer?

A

Stromal invasion only, with a maximum depth of 3mm and no wider than 7mm

47
Q

What is stage 1a2 cervical cancer?

A

Stromal invasion only, with a depth >3mm but <5mm and no wider than 7mm

48
Q

What is stage 1b1 cervical cancer?

A

Clinical lesion confined to cervix, greater than stage 1a and less than 4cm in size

49
Q

What is stage 1b2 cervical cancer?

A

Clinical lesion confined to cervix but greater than 4cm in size

50
Q

What is stage 2a cervical cancer?

A

Tumour extends beyond cervix, no obvious parametrial involvement. Involvement of up to the upper two-thirds of vagina

51
Q

What is stage 2b cervical cancer?

A

Obvious parametrial involvement but not into the pelvic side wall

52
Q

What is stage 3a cervical cancer?

A

Tumour not extending into the pelvic side wall but involves lower third of vagina

53
Q

What is stage 3b cervical cancer?

A

Extension into the pelvic side wall, or hydronephrosis, or non-functioning kidney

54
Q

What is stage 4a cervical cancer?

A

Tumour spread to involve adjacent organs outside of the true pelvis

55
Q

What is stage 4b cervical cancer?

A

Distant metastasis

56
Q

What investigation might be performed in cervical cancer when there is suspicion of adjacent organ involvement?

A

Cystoscopy and sigmoidoscopy

57
Q

Why might a CT or MRI scan be done in cervical cancer?

A

To assess tumour bulk and lymphadenopathy

58
Q

What does the national cervical cancer screening programme offer?

A

A cervical smear every 3 years to women aged 25-30 years, and every 5 years to women aged 50-64 years

59
Q

How do cervical smears work?

A

They use cytology to detect abnormal cells

60
Q

What is the purpose of cervical smears?

A

To prompt intervention to prevent invasive cancer developing

61
Q

What is optimum treatment for cervical cancer determined by?

A
  • Stage of disease
  • Age and general health of woman
  • Plans for future fertility
62
Q

What is the treatment for CIN 2/3 confined to the visible ectocervix?

A

Local excision using loop diathermy

63
Q

What is the treatment for CIN 3 with disease extending into the cervical canal?

A

Loop biopsy

64
Q

What is the treatment for microinvasive cervical cancer?

A

Simple hysterectomy

65
Q

What is the treatment for stage 1b or 2 cervical cancers?

A

Radical hysterectomy with pelvic lymphadenectomy or pelvic radiotherapy

66
Q

What is the treatment for stage 2b or 3 cervical cancers?

A

Pelvic radiotherapy, and if curative intent, chemoradiotherapy with cisplatin as radiation sensitiser

67
Q

What is the treatment for stage 4 and recurrent disease?

A

Chemotherapy, with radiotherapy at specific sites of metastasis

68
Q

Does chemotherapy alone have a role in the adjuvant treatment of cervical cancer?

69
Q

What follow up is provided after treatment for cervical cancer?

A

Patients are reviewed with cervical smears and clinical examination

70
Q

When are patients with CIN 1 reviewed after treatment?

A

6 months, 12 months, and then yearly for 2 years

71
Q

When are patients with CIN2/3 reviewed after treatment?

A

6 months, 12 months, then yearly for 8 years

72
Q

When are patients with invasive disease reviewed after treatment?

A

3 months, 6 months, then every 6 months for 5 years

73
Q

What factors are associated with poor prognosis in cervical cancer?

A
  • Adenocarcinoma
  • Lymph node involvement
  • Advanced clinical stage
  • Large primary tumour
  • Early recurrence
74
Q

At what point is relapse of cervical cancer unusual?

A

After 5 years

Z - Cancer Care Old (28 decks)

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