Cervical cancer COPY Flashcards
What is the natural history of cervical cancer?
1 - Infection with HPV (16 & 18 most common in cervical cancer cases)
2 - HPV becomes incorporated into host cell
3 - HPV persists for between 2-3 years
4 - Cervical Intraepithelial Neoplasia (CIN) develops
5 - Within around 10 years, CIN can then go to develop into cervical cancer
How does the UK HPV Immunisation programme work?
All girls between 12-18 are offered the vaccine against HPV 6,11,16,18
What is the difference between CIN and Cervical cancer?
CIN - Cells still within the basement membrane
Cervical cancer - Cells have spread into surrounding stroma and can spread around into lymph nodes
What is the age of peak prevelance of HPV infection?
15-25 years
In what way can the Cervical cancer screening programme prevent cervical cancer?
Primary prevention - HPV detection (will become part of routine cervical screening checks in 2019)
Secondary prevention - Detect viral lesions and CIN
What factors can increase a womans risk of developing cervical cancer?
Smoking
How is a woman with a positive cervical screening result managed?
- Following a +ve test for changes in the cells of the cervix, the sample will also be tested for high risk HPV (16 & 18) if the cell changes are moderate
- If HPV is also found, the patient will be referred for colposcopy
- If the cervical screening test finds significant cellular changes then the patient will be automatically referred for colposcopy without testing for HPV 16 & 18
How often are woman invited for cervical screening in the UK?
25-49 years old - screened every 3 years
50-64 - screened every 5 years
Which cervical smear results are sent for cytology?
Those which are HPV +ve
From where in the cervix are cells taken for cytological assessment?
Transformation zone
What changes does the cervical epithelium undergo in cervical intraepithelial neoplasia and cervical cancer?
- Columnar epithelium changes into squamous epithelium due to increase in stromal fluid
- This means that the squamo-columnar junction moves higher up in the transformation zone
What are the risk factors for cervical cancer?
HPV Infection
Smoker
Multiple sexual partners
Prolonged OCP use
What investigations are performed to diagnose cervical cancer?
Colposcopy with biopsy
Speculum examination of cervix
What are the symptoms of cervical cancer?
Vaginal bleeding
Post-coital bleeding
Vaginal discharge
Intermenstrual bleeding/PMB
What are the stages of cervical cancer and their cure rates?
1a - 99%
1b - 85%
2a - 75%
2b - 60%
3b - 33%
4 - 15%