Cervical Cancer and Screening Flashcards
How does Cervical Cancer Prevention work ?
- Education to reduce high risk sexual behaviour
- Measures to reduce and avoid exposure to HPV (smear test)
- HPV Vaccination programme
What are the Wilson and Junger’s principles?
‘Principles of early detection’
- Condition must be an important
health problem
- Should be an accepted treatment for patients with disease
-Facilities for diagnosis and treatment should be available
- Should be a suitable test or examination
What is the age of cervical cancer screening in the UK?
25 - 65
How much does preventing invasive tumour save in the UK?
£35,000 per person
What qualities are important in cervical screening?
Validity - does the test separate those who have the condition from those who do not?
Sensitivity - can the test detect those with the disease?
Specificity - does it detect those without the disease?
Reliability - minimal variation over the method which should be quick, simple, acceptable and cheap
What does yield mean in relation with screening programmes?
The measure of previously unrecognized disease that is diagnosed and brought to treatment.
Spikes in yield around introduction of screening and certain events (Jade Goody effect)
Why 25 as the screening age?
- In the young cervix there are constant changes, so sometimes abnormal looking cells could be detected which would self-repair.
- Below 25, risk is a lot lower
What is a Colposcopy?
- not a treatment, but is a diagnostic procedure
- magnified examination of the cervix, vagina and vulva
- helps identify and grade abnormalities
How does a colposcopy work?
- Acetic acid to cervix
- turn white = abnormal cells considered for bipsy
- if no white, schillers test - iodine solution applied, normal cells brown abnormal no change
What are the possible results from colposcopy?
- CIN 1 - one third thickness = abnormal cells
- CIN 2 = two thirds thickness
- CIN 3 / carcinoma in situ - full thickness = abnormal cells
CGIN - cervica;l -> glandular neoplasia
What if no CIN is found?
- Recall in 36 months
No CIN up to and including High grade dyskarosis/borderline discovered?
- Discuss at MDT within two months
What are the options for CIN1?
- More than fifty percent will regress over 22 months#
- 12 month recall for smear
- Test hrHPV
- If -ve, 36 month recall
- If +ve then proceed to cytology test
- If cytology is negative then another test in 12 months
- Abnormal cytology, refer to colposcopy.
What are the options for CIN 2/3
- treat and recall in 6 months
- test for hrHPV
- if -ve, recall in 36 months
- if +ve refer for colposcopy
Treatment for CGIN?
- Treatment and recall within 6 months
- If -ve, recall in 12 months the afterwards 36 months if still negative
- If positive proceed to colposcopy
- if cytology and colposcopy then recall in 12 months
- repeat until hrHPV is negative
What is LLETZ?
- Removal of abnormal cells, most common treatment
- Totally removes abnormal cells
- Wire loop with electric current, leaving a raw area which heals over time
What is a cone biopsy and why is it used?
- removes a larger area than LLETZ, allows the whole area to be viewed
- Perfromed under GA
Is hysterectomy used?
- rarely, perhaps after multiple local treatments.
- if other gynaecological conditions are present
Are there other therapies not used much in the UK?
- Laser, vaporises or cut out core tissue for exam
- Cryotherapu for low grade CIN
What is the major cause of cervical cancer?
HPV infection is the major cause.
Present in 70% of cases.
What are the risk factors of cervical cancers?
- Infection with HIV and other STIs
- Smoking - linked to SCC and immune system
- Contraceptive pill
- Number of pregnancies
- Age at first pregnancy
- Family history
- Previous cancer
- Living in a deprived area
What is the typical histology of cervical cancer?
- Normally squamous cell carcinoma, 85%
- Some Adenocarcinoma - 10%
What is the transformation Zone?
- The area at which screening occurs, where cells are most likely to change - entrance of cervix.
What are the symptoms of cervical cancer?
- Bleeding (major symptom)
- Pain during sex
- Unusual discharge
- Fistula
- Compression of ureters
How does cervical cancer tend to spread?
- To adjacent structures
- Along epithelial surfaces of the uterus
- Through interstitial spaces of parametrial tissue
Where is superior spread of cervical cancer?
Uterine Body
Where is inferior spread of cervical cancer?
The vaginal vault
Where does cervical cancer spread laterally?
To the parametria and on to lateral walls of pelvis
Where does cervical cancer spread anteriorly?
To the bladder
Where does cervical cancer spread posteriorly?
To the rectum
