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4th year passmedicine by topic > Cervical Disease > Flashcards

Cervical Disease Flashcards

1
Q

Around 50% of cases of cervical cancer occur in women under the age of 45 years

A

true

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2
Q

cervical cancer in the UK are highest in people aged

A

25-29 years

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3
Q

Types of cervical cancer

A

squamous cell cancer (80%)

adenocarcinoma (20%)

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4
Q

Features of cervical cancer

A

may be detected during routine cervical cancer screening
abnormal vaginal bleeding: postcoital, intermenstrual or postmenopausal bleeding
vaginal discharge

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5
Q

Which virus is commonest for cervical cancer?

A

Human papillomavirus (HPV), particularly serotypes 16,18 & 33

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6
Q

Rx factors cervical cancer?

A 
smoking
human immunodeficiency virus
early first intercourse, many sexual partners
high parity
lower socioeconomic status
combined oral contraceptive pill*
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7
Q

Mechanism of HPV causing cervical cancer

A

HPV 16 & 18 produces the oncogenes E6 and E7 genes respectively
E6 inhibits the p53 tumour suppressor gene
E7 inhibits RB suppressor gene

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8
Q

The UK has a well established cervical cancer screening program which is estimated to prevent 1,000-4,000 deaths per year.

A

true

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9
Q

The main aim of cervical screening

A

detect pre-malignant changes rather than to detect cancer

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10
Q

cervical adenocarcinomas, which account for around 15% of cases, are frequently undetected by screening

A

true

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11
Q

Who is screened and how often? A smear test is offered to all women between the ages of

A

25-64 years

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12
Q

Cervical cancer screening 25-49 years:

A

3-yearly screening

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13
Q

Cervical cancer screening 50-64 years:

A

5-yearly screening

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14
Q

cervical screening cannot be offered to women over 64

A

true

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15
Q

cervical screening in pregnancy

A

usually delayed until 3 months post-partum unless missed screening o

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16
Q

women who have never been sexually active have very low risk of developing cervical cancer therefore they may wish to opt-out of screening

A

True

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17
Q

Cervical screening - How is performed?

A

There is currently a move away from traditional Papanicolaou (Pap) smears to liquid-based cytology (LBC). Rather than smearing the sample onto a slide the sample is either rinsed into the preservative fluid or the brush head is simply removed into the sample bottle containing the preservative fluid.

It is said that the best time to take a cervical smear is around mid-cycle. Whilst there is limited evidence to support this it is still the current advice given out by the NHS.

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18
Q

Advantages of LBC includes

A

reduced rate of inadequate smears

increased sensitivity and specificity

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19
Q

management is based solely on the degree of dyskaryosis

A

false

The introduction of HPV testing allowed patients with mild dyskaryosis to be further risk-stratified

20
Q

HPV is such a strong risk factor patients who were HPV negative could be treated as having normal results.

A

true

21
Q

The NHS has now moved to an HPV first system what does this mean

A

sample is tested for high-risk strains of human papillomavirus (hrHPV) first and cytological examination is only performed if this is positive.

22
Q

Management of results - negative hrHPV

A

return to normal recall, unless:

the test of cure (TOC) pathway: individuals who have been treated for CIN1, CIN2, or CIN3 should be invited 6 months after treatment for a test of cure repeat cervical sample in the community

the untreated CIN1 pathway

follow-up for incompletely excised cervical glandular intraepithelial neoplasia (CGIN) / stratified mucin producing intraepithelial lesion (SMILE) or cervical cancer

follow-up for borderline changes in endocervical cells

23
Q

Management of results - positive hrHPV

A

samples are examined cytologically

different mx based on cytology abnormal/normal

24
Q

Management of results - positive hrHPV if the cytology is abnormal

A 
this includes the following results:
borderline changes in squamous or endocervical cells.
low-grade dyskaryosis.
high-grade dyskaryosis (moderate).
high-grade dyskaryosis (severe).
invasive squamous cell carcinoma.
glandular neoplasia

if the cytology is abnormal → colposcopy

25
Q

Management of results - positive hrHPV if the cytology is normal

A

if the cytology is normal (i.e. hrHPV +ve but cytologically normal) the test is repeated at 12 months

if the repeat test is now hrHPV -ve → return to normal recall
if the repeat test is still hrHPV +ve and cytology still normal → further repeat test 12 months later:
If hrHPV -ve at 24 months → return to normal recall
if hrHPV +ve at 24 months → colposcopy

26
Q

Management of results - positive hrHPV

If the sample is ‘inadequate’

A

repeat the sample within 3 months

if two consecutive inadequate samples then → colposcopy

27
Q

The follow-up of patients who’ve previously had CIN is complicated but as a first step,

A

individuals who’ve been treated for CIN1, CIN2, or CIN3 should be invited 6 months after treatment for a test of cure repeat cervical sample in the community.

28
Q

The management of cervical cancer is determined by the

A

FIGO staging and the wishes of the patient to maintain fertility.

29
Q

FIGO Stage IA

A

Confined to cervix, only visible by microscopy and less than 7 mm wide:
A1 = < 3 mm deep
A2 = 3-5 mm deep

30
Q

FIGO Stage IB

A

Confined to cervix, clinically visible or larger than 7 mm wide:
B1 = < 4 cm diameter
B2 = > 4 cm diameter

31
Q

FIGO Stage II

A

Extension of tumour beyond cervix but not to the pelvic wall
A = upper two thirds of vagina
B = parametrial involvement

32
Q

FIGO Stage III

A

Extension of tumour beyond the cervix and to the pelvic wall
A = lower third of vagina
B = pelvic side wall

NB: Any tumour causing hydronephrosis or a non-functioning kidney is considered stage III

33
Q

FIGO Stage IV

A

Extension of tumour beyond the pelvis or involvement of bladder or rectum
A = involvement of bladder or rectum
B = involvement of distant sites outside the pelvis

34
Q

Management of stage IA tumours

A

Gold standard of treatment is hysterectomy +/- lymph node clearance - nodal clearance for A2 tumours

For patients wanting to maintain fertilit:
A cone biopsy with negative margins can be performed

Close follow-up of these patients is advised - For A2 tumours, node evaluation must be performed

Radical trachelectomy is also an option for A2

35
Q

Management of stage IB tumours

A

For B1 tumours: radiotherapy with concurrent chemotherapy is advised
Radiotherapy may either be bachytherapy or external beam radiotherapy
Cisplatin is the commonly used chemotherapeutic agent
For B2 tumours: radical hysterectomy with pelvic lymph node dissection

36
Q

Management of stage II and III tumours

A

Radiation with concurrent chemotherapy

If hydronephrosis, nephrostomy should be considered

37
Q

Management of stage IV tumours

A

Radiation and/or chemotherapy is the treatment of choice

Palliative chemotherapy may be best option for stage IVB

38
Q

Management of recurrent disease

A

Primary surgical treatment: offer chemoradiation or radiotherapy
Primary radiation treatment: offer surgical therapy

39
Q

The prognosis of cervical cancer is dependant on the FIGO staging:

A

I 1yr 99% 5yr96%
II 1yr85% 5yr54%
III 1yr74% 5yr38%
IV 1yr35% 5yr5%

40
Q

Cervical cancer - Complications of surgery

A

Standard complications (e.g. bleeding, damage to local structures, infection, anaesthetic risk)

Cone biopsies and radical trachelectomy may increase risk of preterm birth in future pregnancies

Radical hysterectomy may result in a ureteral fistula

41
Q

Cervical cancer - Complications of radiotherapy

A

Short-term: diarrhoea, vaginal bleeding, radiation burns, pain on micturition, tiredness/weakness
Long-term: ovarian failure, fibrosis of bowel/skin/bladder/vagina, lymphoedema

42
Q

What is a Cervical Ectropion

A

Elevated oestrogen levels result in larger area of columnar epithelium being present on the ectocervix

43
Q

What is in the transformation zone?

A

On the ectocervix there is a transformation zone where the stratified squamous epithelium meets the columnar epithelium of the cervical canal.

44
Q

What can elevate oestrogen levels

A

ovulatory phase, pregnancy, combined oral contraceptive pill use

45
Q

Features of cervical etropion?

A

vaginal discharge

post-coital bleeding

46
Q

Mx cervical ectropion

A

Ablative treatment (for example ‘cold coagulation’) is only used for troublesome symptoms

4th year passmedicine by topic (96 decks)

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