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Reproduction Pathology > Cervical Screening; the prevention of cervical cancer > Flashcards

Cervical Screening; the prevention of cervical cancer Flashcards

1
Q

Age of peak prevalence of HPV infection

A

15-25 years old

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2
Q

Why is 15-25 years of age the peak prevalence from HPV infection?

A

Predisposed to sex

Multiple partners

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3
Q

The incidence of HPV infection in correlation with age

A

Prevalence declines with age

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4
Q

Prevalence in young women and men of HPV

A

approx. 30%

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5
Q

Lifetime risk exposure of HPV

A

75%

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6
Q

High risk HPV causes what type of cancers?

A

Cervix (>99% caused by HPV)
Penis (>40% caused by HPV)
Vulva/vaginal (>40% caused by HPV)
Anus (>90% caused by HPV)

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7
Q

Almost 100% of cervical cancer is caused by…

A

HPV

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8
Q

HPV stands for….

A

Human Papilloma virus

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9
Q

High rates of anal HPV are reported in….

A

MSM

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10
Q

Pathology of HPV infection in the cervix

A

Early HPV infections may be accompanied by mild changes in the epithelium
Abnormal growth of squamous cells detectable on smear called a squamous intraepithelial lesion (SIL)
HPV affects the basal cells
It doesn’t send out signals to the immune system like the common cold or flu etc
Abnormal cells detected on biopsy classified as cervical intraepithelial neoplasia (CIN)

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11
Q

Types of squamous intraepithelial lesion (SIL)

A 
Low grade (LSIL)
High grade (HSIL)
Depending on how much of the cervical epithelium is affected and how abnormal the cells appear
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12
Q

Grading of CIN

A

Graded 1 to 3 according to the proportion of the cervix affected

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13
Q

What cells does HPV affect?

A

The basal cells

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14
Q

Stages of HPV infection into the cervix

A

stage I - infectious viral particles enter the skin through a break in the skin (called a micro-abrasion) which can be as small as 40 cells deep. They invade the basal cells where they can stay for several years with no ill effects but the women is a carrier and therefore a potential spreader of the disease

stage II (Grade I CIN)- the virus begins to mix with the cells DNA, replicates and starts to spread by invading other cells. The changes to cells can be observed as low grade pre cancerous lesions that can be picked up by screening and treated

Stage III (Grade 2 CIN) - the cells become more damaged and disorganised - resulting in a high grade lesion

Stage IV (Grade 3 CIN) - the high grade pre cancerous lesion grows and occupies almost the entire thickness of the skin

Stage 5 (invasive cancer) - all the cells have been infected and are completely disorganised producing an invasive cancerous growth tumour that can break through the inner layer of the skin and spread to other parts of the body

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15
Q

Stage 2 to stage 4 of HPV infection in the cervix are what kind of lesion?

A

Pre-cancerous lesions - cervical intraepithelial neoplasias (CIN)

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16
Q

How long can it take to clear the HPV?

A

2 - 3 years

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17
Q

What does CIN1/2 have the potential to progress to?

A

Cancer

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18
Q

Type of HPV infection with the highest risk

A

HPV 16/18

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19
Q

UK immunisation programme against HPV involves…

A

Quadravalent vaccine HPV 16/18/6/11
2 dose regime
Vaccinating girls between ages 16-18

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20
Q

Why is cervical cancer linked to cigarette smoking?

A

As nicotine is excreted in the cervical mucus

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21
Q

Scenarios in cervical smears where you would have to think about where you would sample

A

Pregnancy
Contraceptive pill
Menopause

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22
Q

Who gets screened for cervical cancer?

A

Women aged 25-64 years

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23
Q

How often are cervical smears done?

A

If aged 25 - 49 - every 3 years

If aged 50 - 64 - every 5 years

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24
Q

What happens in a cervical smear?

A

Liquid based cytology (LBC)
Test for high risk HPV
If positive; triage with cytology

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25
Q

If have had a hysterectomy, do they need a smear?

A

No, as do not have a cervix

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26
Q

What tests are done in a cervical cytology sample if HPV +ve?

A

microscopic assessment of cells scraped from the transformation zone
Looks for abnormal cells (dyskaryosis)
Indicate that women has cervical intraepithelial neoplasia (CIN)

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27
Q

Two components of the cervical canal

A 
Endocervix = columnar epithelium 
Ectocervix = squamous epithelium
28
Q

What is the transition zone of the cervix especially vulnerable to?

A

Infection e.g. HPV

29
Q

Another name for the transformation zone?

A

Squamo-columnar junction

30
Q

Name of abnormal cytological cells of the cervix

A

Dyskaryosis

31
Q

Nuclear features of dyskaryosis

A

Increased size and nuclear:cytoplasmic ratio
Variation in size, shape and outline
Coarse irregular chromatin
nucleoli

32
Q

What do koilocytes reflect?

A

HPV infection

33
Q

What happens after HrHPV infection?

A

Negative for HrHPV = routine recall 3 or 5 years
Postive for HrHPV
- cytology normal; repeat test 1 year
- dyskaryosis; refer to colposcopy

34
Q

What is a colposcopy?

A

Further investigation of an abnormal smear - magnification and light to see the cervix

35
Q

What does acetic acid (+/- lodene) in colposcopy do?

A

Identify limits of lesion
Select biopsy site
Define area to treat

36
Q

HPV related pathologies changes to the transformation zone of the cervix

A
  1. HPV infection
  2. Pre-cancerous changes cervical intraepithelial neoplasia (CIN)
  3. Cervical carincoma
37
Q

As the host cell infected with HPV matures, what different viral genes are expressed?

A

E7 protein product = prevents cell cycle arrest

E6 protein product = inhibits cell death

38
Q

Koilocytos histology

A

Cells with wrinkled nucleus and perinuclear halo

Multinucleation

39
Q

Low risk types of HPV

A

6, 11, 42, 44

40
Q

What do low risk types of HPV cause?

A

Genital warts

Low grade CIN

41
Q

Do low risk types of HPV resolve?

A

Yes, they are often transient and resolve

42
Q

High grade risk types of HPV

A

16, 18, 31, 45

43
Q

What do high risk types of HPV cause?

A

Persistent infection increasing risk of developing high grade CIN and (more rarely) cancer

44
Q

Can you see cervical intraepithelial neoplasia (CIN)?

A

No, it is invisible to the naked eye

45
Q

Disorganised proliferation of abnormal cells in squamous epithelium (dysplasia) seen on histology as….

A 
Lack of maturation 
Variation in cellular size and shape
Nuclear enlargement 
Irregularity 
Hyperchromasia
Cellular disarray
46
Q

CIN stages and their dysplasia and related regression

A

CIN1 - low grade dysplasia - will regress
CIN2 - moderate dysplasia - may regress
CIN3 - severe dysplasia - unlikely to regress

47
Q

Treatment of CIN

A

LLET2
Thermal coagulation
Laser ablation (uncommon now)

48
Q

Residual disease of treated CIN would happen in how long?

A

within 2 years

49
Q

Recurrent disease of CIN turning into invasive cancer occurs how often?

A

5% after 3-5 years

50
Q

Follow up after treatment of CIN

A

Follow up LBC after 6 months for cytology and high risk HPV

  • both negative = return to recall
  • both positive = return to colposcopy
51
Q

Does cervical screening reduce the rate of cervical cancer?

A

Yes

52
Q

Peak age of cervical cancer

A

45-55 years

53
Q

Risk factors for cervical cancer

A 
HPV related (16 and 18)
Multiple partners 
Early age at first intercourse 
Older age of partner 
Cigarette smoking
Low socioeconomic status
High parity
54
Q

Types of tumour cells of cervical cancer

A

Majority squamous carcinoma (80%)

Adenocarcinoma (endocervical) - rising in incidence

55
Q

Symptoms of cervical cancer

A 
Abnormal vaginal bleeding
Post coital bleeding
Intermenstrual bleeding
Post menopausal bleeding 
Discharge
Pain
Weight loss
56
Q

Investigations of cervical cancer

A

Clinical
Screening
Biopsy

57
Q

Staging investigations for cervical cancer

A

Examination under anaesthetic (especially rectal)
PET-CT
MRI

58
Q

Aim of cervical screening

A

To detect PRE-CANCEROUS disease, NOT CANCER

59
Q

Stages of cervical cancer

A 
Stage 1A 
- invasive cancer only identified microscopically
Stage 1B
- clincial tumours confined to the cervix 
Stage 2 - 4
- cancer has spread
- 2 = upper 2/3rds of vagina
- 3 = lower vagina, pelvis
- 4 = bladder, rectum
60
Q

Spread of cervical cancer by lymphatic spread goes to …..

A

Pelvic nodes

61
Q

Spread of cervical cancer by haematogenous spread to….

A

liver
lungs
bones

62
Q

Treatment of cervical cancer

A

Stage IA; type 3 excision of cervical TZ/hysterectomy
Stage IB-2A; radical hysterectomy or chemoradiotherapy
Stage 2B-4; chemo-radiotherapy
Caesium insertion (24 hours)

63
Q

Is cervical cancer sensitive to radiation?

A

Yes, very

64
Q

What is a caesium insertion?

A

Type of internal radiotherapy treatment which is used for treating cancers of the cervix, uterus or vagina
Gives high dose of radiotherapy to tumours but gives a low dose to the normal tumours

65
Q

When should a woman wait post partum for her routine cervical smear?

A

12 weeks post partum (unless previous abnormal smear)

66
Q

Women with stage IA cervical cancer can be considered for what treatment if they wish to maintain their fertility?

A

Cone biopsy with negative margins

Reproduction Pathology (28 decks)

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