Cervical Cancer + screening Flashcards
What is the main cause of cervical cancer?
HPV (Human papilloma virus)
What is HPV?
Human papilloma virus is a sexually transmitted disease. There is over 100 strains. Most people will get some sort of HPV in their lifetime.
Which cancers can HPV cause?
Cervical Head and neck Anal Penile Vulval Vaginal
Which types of HPV can give rise to cancer?
Type 16 and 18
^These account for 70% of the cancers.
What is the treatment for HPV?
NO treatment
Most will resolve within 2 years
How does HPV cause cancer?
It inhibits tumour suppressor genes.
What are the signs of cervical cancer seen on examination?
Ulceration, inflammation, bleeding or visible tumour.
What is the first line investigation for cervical cancer?
Urgent Colposcopy - visualisation and biopsy
What is the most common type of cervical cancer?
Squamous cell carcinoma 80%
(followed by cervical adenocarcinoma)
You can get a combination of squamous-adenocarcinomas.
How long does HPV take to transform into cancer?
10-20 years from the initial infection.
What are the signs and symptoms to suggest cervical cancer?
Post-coital bleeding abnormal vaginal bleeding discharge (often with an unpleasant smell) Painful Urinating Vaginal discomfort Mass felt on examination Suprapubic pain White and red patches seen on the cervix Pelvic bulkiness on examination Changes in urinary/bowel habit
What is tested during a Pap smear test?
cells from the transitional zone of the cervix are tested for dysplasia.
What is done if the cervical cells are dysplastic on smear test?
Followed up by an urgent colposcopy
What are the zones of the cervix?
Endocervix - on top (glandular epithelium - secretes mucus)
Middle - transitional zone
Ectocervix - below (has squamous epithelium)
What are the risk factors for cervical cancer?
Multiple sexual partners
HPV (16 or 18) infection
Smoking
Immunocompromised
Early age of first intercourse
Older age of partner (more likely to have an infection)
Exposure to diethylbestrol as a foetus (used to be used to prevent miscarriages)
Combined contraceptive pill (for >5yrs)
Increased number of full term deliveries
Pain is uncommon (only in advanced disease)
How often is a Pap smear test done?
EVERYONE NOW 25-64 = 5 yearly
HIV = every 1 year
Which strains does the HPV vaccine protect against?
Cervical cancer - strains 16 and 18
Genital warts - strains 6 and 11
(it maybe also protects against strains 31, 33 and 35).
How much cases of cervical cancer are caused by HPV?
> 99%
What type of cervical cancer is not related to HPV?
Neuroendocrine cancer - VERY rare.
What is the peak age for cervical cancer?
45-55yrs.
Why is a younger age of first intercourse a risk factor for cervical cancer?
The cervix is more immature so is susceptible to HPV infections.
What is the name of the HPV vaccine?
Garsadil.
Who is given the HPV vaccine?
Girls and boys around 12-13yrs old (ideally, before they become sexually active).
What is a red flag symptom for cervical cancer?
Post-coital bleeding.
What is a smear test for?
ASYMPTOMATIC patients. Its not a test for cancer.
How is cervical cancer detected?
Clinically - when it is seen and a biopsy is done.
Biopsy - done to confirm the diagnosis
Screen detected - when it has been detected through the smear (so they are asymptomatic)
What is cervical intraepithelial neoplasia?
The grading system for dysplasia (only diagnosed at colposcopy, not smear)
What does the smear look for?
Dyskaryosis - changes to the cells that line the cervix.
What are the stages of cervical cancer?
IA1 - just seen microscopically <3mm depth and <7mm diameter
IA2 - just seen microscopically, <5mmx7mm, usually has lymph node involvement
IB - clinical tumours confined to the cervix.
Where does cervical cancer often spread to?
Pelvic lymph nodes (internal, external and common iliac lymph nodes) or the para-aortic lymph nodes.
Blood (uncommon) - to the liver, lungs and bone
What are the stages of local cervical cancer?
Stage 2 - upper 2/3 of vagina
Stage 3 - lower vagina, pelvis (lymph nodes or parametric)
Stage 4 - bladder, rectum or distant
How is cervical cancer staged?
PET-CT
MRI
^Both are done.
What is the treatment for IA stages?
Conisation
Or radical trechelectomy
Both spare fertilisation
Radical hysterectomy and lymphadenopathy - if fertilisation doesn’t need to be spared.
What is a radical trachemectomy?
Removal of cervix, upper vagina and pelvic lymph nodes.
KEEPS UTERUS AND OVARIES (uterus is stitched to the vagina)
Baby would have to be delivered by C section.
What is a radical hysterectomy?
Removal of uterus, cervix, upper vagina, parametric, pelvic nodes.
OVARIES ARE PRESERVED.
What type of C section should be done if the women has had a radical hysterectomy?
A midline incision.
What is the treatment for invasive, infiltrating or EARLY metastatic cancer?
Wertheim’s hysterectomy - removal of uterus, primary tumour, lymph nodes, upper vagina, uterovesical and uterosacral ligaments.
What is the treatment for advanced incurable cervical cancer?
Radiotherapy and/or chemotherapy.
How many people clear a HPV infection?
90% of people will clear the infection.
What causes CIN - Cervical intraepithelial neoplasia?
Persistence of the HPV infection.
How many HPV strains can cause cancer?
13 types.
Types 16 and 18 are most common (>70% of cervical cancers)
Who determines when you get your cervical smear test?
Scottish cervical call recall system (SCCRS)
What is the smear test collected in?
Liquid based cytology.
Where on the cervix specifically is tested during a smear test?
The transitional zone - where most HPV and pre-cancerous changes can be seen.
Where on the cervix specifically is tested during a smear test?
The transitional zone - where most HPV and pre-cancerous changes can be seen.
What is the new cervical screening?
It is a HPV test, NOT cytology.
What is done if the HPV test is positive?
Cytology (on the same sample) - then if this shows dyskaryosib - its colposcopy, if it is normal, repeat HPV test 1 year later.
What does cytology show?
Dyskaryosis
Low grade or high grade
High grade is more likely to have CIN.
What is done if the colposcopy is not normal?
A biopsy is taken (punch biopsy or excision biopsy).
OR treatment is given at the first appointment.
What are the stages of CIN?
CIN 1 - low grade dysplasia which will regress
CIN 2 - moderate dysplasia which might regress (especially if under 30)
CIN 3 - severe dysplasia - unlikely to regress, most advocate treatment
What is the treatment for CIN2/3?
Large loop excision of the transitional zone.
thermal/laser ablation of transitional zone
What is the follow up after CIN treatment?
Liquid based cytology at 6 months - if negative, return to 3 year recall, if positive, return to colposcopy.
