Cervical Cancer CPC Flashcards
High-risk HPV causes other less common cancers such as what?
acounts for nearly all cervical cancers
how does HPV cause cervical cancer?
10-20 years form HPV infection to get a cancer
what is the epidemiology of cervical cancer?
2500 cases per year in UK
1200 deaths
10th commonest cancer in women in Scotland
Good cure rate if detected early (particularly if we can prevent it by detecting precancer changes)
BUT major cause of death in in women in low income countries
Accumulation of global HPV vaccine experience, October 2016 - what countries have vaccination?
mainly high income countries with low rates of disease (eception of south american counties)
who tends to get cervicl cancer?
Peak age 45-55 years
HPV related (16 & 18)
Multiple sexual partners
Early age at first intercourse
Older age of partner (more likely to have HPV infection)
Cigarette smoking (effects cell mediated immunity)
what are the rates in different age groups?
how is cervical cancer related to deprivation?
most deprived - less likely to get screening and more likely to smoke cigarettes, nutrition may also indicate
in scotland we lose this link of deprivation due to the high uptake of HPV vaccine in kids at school
how has the incidence of cervical cancer changed?
Case:
40 year old P3 attends GP with heavy irregular periods
GP notices she has not had a cervical screening test since 2005
She says she does not have post coital bleeding (red flag symptoms of cervical cancer)
She does not have a regular partner and because of the bleeding she does not have sex
She smokes 25/day
GP does a speculum examination and large cervix
looks quite irregular
what should her GP do next?
- Take a smear test as it is overdue?
- Take a chlamydia test as her history suggests chlamydia cervicitis?
- Take a swab for high risk HPV?
- Take a biopsy in case it is cancer?
- Refer as urgent suspected cancer to Gynaecology?
5
due to her history and suspicious history
smear is for asymptomatic women and is not for cancer
what are the symptoms of cervical cancer?
Abnormal vaginal bleeding
Post coital bleeding
Intermenstrual bleeding/PMB
Discharge
(Pain)
how is the diagnosis of cervical cancer made?
Clinical
Screen detected - smear taker visualises the cancer but the patient is asymptomatic
Biopsy
Remember screening aims to detect pre-cancerous disease NOT cancer
biopsy is crucial
what is the histology of a cancer like? and what types is there?
Difference between a CIN and a cancer is - Tumour cells from epithelium invade into underlying stroma
Majority squamous carcinoma (80%)
Adenocarcinoma (endocervical) rising in relative incidence
(biopsy from patient, cant see basement membrane thats been disrupted, darkly staining dysplastic cells invading into the underlying stroma)
how is stage 1A identified? and what is it?
nothing clinical to see
Stage IA: Invasive cancer identified only microscopically
IA1 ≤ 3 mm depth and ≤7 mm diam (=microinvasive)
IA2: ≤ 5 mm x7 mm
what is a stage 1B tumour?
Stage IB: clinical tumours confined to the cervix
most cancers in young women are stage 1A or stage 1B
where does cervical cancer spread? and what are the different stages?
Local:
- stage 2: Vagina (upper 2/3),
- Stage 3: lower vagina, pelvis,
- Stage 4 bladder, rectum
metastases (tender to be local spread in cervical cancer):
- Lymphatic – pelvic nodes
- Blood – liver, lungs, bone
what is used to stage cervical cancer?
use imaging to stage cancer to indivisualse the treamtent and we tend to do both of these:
- PET-CT
- MRI
what is the treatment of cervical cancer?
Stage 1a1: Type 3 Excision of the cervical TZ (loop excision same as CIN3) or hysterectomy
Stage 1b - 11a: Radical hysterectomy (preserves ovaries for premenopausal women) or chemo-radiotherapy
Stage 11b - 1V: Chemo-Radiotherapy
what is a radical hysterectomy and what is removed?
Exploration of pelvic and para-aortic space
Removal of:
- Uterus, cervix, upper vagina
- Parametria
- Pelvic nodes
- Ovaries conserved (conserved in pre-menopausal women)
cervical cancer treatment - how is radiotherapy and chemotherapy done?
Radiotherapy- External Beam
Chemotherapy - once weekly during radiotherapy
Brachytherapy - Caesium Insertion (24 hours)
what is the mortality rate of cervical cancer?
lot sof cases in younger women but higher mortality in older women who are more likely to present with advanced disease
what is the survival rate of cervicla cancer?
survival rate is stage dependant
What to remember:
Major cause of female death in _________ world
___ is single most important cause
Screening detects _________ changes which are _____________
Cancer causes ________ ______ ______ (so important to look at the cervix)
Surgery or combined ___________
Effective cure of _____ _____ disease
developing
HPV
pre-invasive
asymptomatic
abnormal vaginal bleeding
chemoradiation
early stage
