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Reproductive System > Cervical Screening + Cervical Cancer > Flashcards

Cervical Screening + Cervical Cancer Flashcards

1
Q

what is HPV?

A

Human Papilloma Virus

  • main cause of cervical cancer
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2
Q

peak prevalence of HPV?

A

15-25 years but prevalence reduces with age

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3
Q

what is HPV infection of cervix associated with?

A

changes in the epithelium called cervical intraepithelial neoplasia (CIN)

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4
Q

what is CIN and what may it be a precursor to? (not always)

A
  • abnormal proliferation of cells in squamous epithelium (neoplasia = new cells) which is invisible to naked eye
  • precursor to invasive cancer
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5
Q

outline the grading of CIN

A
  • grade 1
    • 1/3 of thickness of surface layer affected
  • grade 2
    • 2/3 of thickness of surface layer affected
  • grade 3
    • full thickness of surface layer affected
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6
Q

what may happen to CIN?

A

may regress, remain unchanged or persist

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7
Q

what % of grade 3 CIN goes on to become invasive cancer?

A

20% over 10-20 years if left untreated

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8
Q

outline when screening takes place and what is the medium used

A
  • every 5 years from 25-64 years old
  • liquid based cytology
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9
Q

outline the process of screening

A
  • samples are tested for HPV infection
    • If HPV negative
      • recall again in 5 years time for routine screening
    • If HPV positive
      • ​reflex cytology of sample
        • if cytology normal= repeat test in 1 year
        • if cytology abnormal = Colposcopy
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10
Q

where is it important to take a smear from and why ?

A

transition zone of cervix

  • because CIN occurs mainly in squamocolumnar junction - between sqamous cells of ectocervix and columnar cells of endocervix
  • is the site of HPV infection
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11
Q

what happens in the transformation zone with CIN?

A

columnar cells of endocervical epithelium are transformed into squamous cells

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12
Q

what is cervical cytology?

A
  • microscopic assessment of cells scraped from transformation zone
  • looking for abnormal cells (dyskaryosis), which is suggestive of underlying CIN
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13
Q

what are benign nuclear features?

A
  • small
  • fine regular chromatin
  • equal size/shape
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14
Q

what are abnormal nuclear features?

A
  • increase in nucleus: cytoplasmic ratio
  • variation in size / shape
  • coarse, irregular chromatin
  • nucleoli
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15
Q

how is dyskariosis graded?

A

high or low grade

  • reflects degree of underlying CIN
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16
Q

what is colposcopy and what options do you have while you are doing it?

A

magnification + light to see the cervix

Options:

  • punch biopsy –> to make diagnosis
  • if CIN 2/3 come back another time to treat
17
Q

How does HPV infection affect the epithelial cells of cervix?

A
  • infects basal layer
  • uses host for replication
  • when host cell matures–> expression of viral genes
18
Q

what is the appearance of HPV on histology?

A
  • koilocytes
    • cells with wrinkled nuclei + perinuclear halo
    • multinucleated
19
Q

risk factors for CIN?

A
  • HPV infection (types 16 and 18)
  • early age of 1st intercourse
  • multiple sexual partners
  • prolonged OCP use
  • smoking
  • STD
  • immunodeficiency
  • persistent infection
20
Q

Treatment of CIN?

A
  • LLETZ
    • Large Loop Excision of Transition Zone
  • thermal coagulation
  • laser ablation
21
Q

what is the epidemiology of cervical cancer?

A

mostly women 45-55

22
Q

risk factors of cervical cancer?

A
  • HPV
  • early age of 1st intercourse
  • multiple sexual partners
  • smoking
23
Q

symptoms of cervical cancer?

A
  • abnormal vaginal bleeding
  • discharge
  • pain
  • IMB / post-coital
24
Q

diagnosis of cervical cancer?

A
  • asymptomatically - screening
  • clinical - symptoms + examination
  • BIOPSY
  • staging
    • PET-CT
    • MRI
    • EUA (examination under anaesthesia)
25
Q

management of cervical cancer?

A
  • Radical Hysterectomy
    • removal of upper vagina, cervix, uterus and pelvic nodes MINUS ovaries
  • chemotherapy
  • radiotherapy

Reproductive System (32 decks)

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