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Reproduction SOH > Cervical tumours > Flashcards

Cervical tumours Flashcards

1
Q

Which infection can increase risk cervical cancer?

A

HPV infection

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2
Q

What are the 2 main high risk HPV types?

A

Type 16 and 18

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3
Q

Before HPV develops into cancer, what does it develop into first?

A

CIN (cervical intraepithelial neoplasia)

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4
Q

HPV infection -> high grade CIN takes weeks/months/years ?

A

6 months -> 3 years

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5
Q

High grade CIN -> invasive cancer takes weeks/months/years?

A

5-20 years

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6
Q

Which age group is the HPV infection most common in?

A

15->25 year old

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7
Q

What is CIN ?

A

Pre-invasive stage of squamous cervical cancer

There is dysplasia of squamous cells but they are not yet cancerous

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8
Q

Which part of the cervix is most commonly involved?

A

Transformation zone

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9
Q

CIN - clinical features

A

Asymptomatic

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10
Q

CIN - how is it detected ?

A

Cervical screening

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11
Q

CIN - Grading options

A

CIN 1
CIN 2
CIN 3

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12
Q

CIN 1

A

Lower 1/3rd of epithelium is occupied by abnormal cells

- raised numbers of mitotic figures here

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13
Q

CIN2

A

Middle (and lower) section of epithelium is occupied by abnormal cells
- raised numbers of mitotic figures in middle and lower section

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14
Q

CIN3

A

Abnormal cells occupy the entire epithelium

- raised number of mitotic figures in upper, middle and lower section

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15
Q

Which grade of CIN is most likely to develop into invasive cancer ?

A

CIN3

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16
Q

CIN is basically carcinoma in situ. True or false?

A

True

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17
Q

Histology of CIN

A

Delay in maturation - immature basal cells occupying more of epithelium

Increased N:C ratio
Pleomorphism
Hyperchromasia - dark staining nuclei

Abnormal mitotic figures

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18
Q

If you identify CIN, it can be treated before it develops into an invasive cancer. True or false?

A

True

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19
Q

Risk factors for developing cervical cancer

A 
Persisting HPV infection 
- mainly types 16 and 18
Smoking 
Immunosuppression 
Increased number of sexual partners 
OCP
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20
Q

Transitional zone of cervical epithelium is more vulnerable to HPV virus in early/late reproductive life?

A

Early

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21
Q

What can be detected on cervical smears that suggests CIN is present?

A

Koilocytosis

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22
Q

What is koilocytosis?

A

Abnormal black nuclei

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23
Q

How does CIN develop into cancer?

A

Has to break through the basement membrane

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24
Q

How long does it take for CIN to develop into cancer?

A

5-20 years

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25
Q

What is CIN ?

A

Pre-invasive stage of squamous cervical carcinoma

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26
Q

What is CGIN

A

Pre-invasive stage of endocervical adenocarcinoma

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27
Q

What is VIN?

A

Vulvar intraepithelial neoplasia

Often HPV related

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28
Q

Who gets VIN?

A

Often extremes of age

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29
Q

VIN is linked to which condition?

A

Pagets disease

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30
Q

Pagets disease - histopathology

A

Large malignant cells look like balloons that are going through the epidermis

31
Q

Cervial cancer - which age range is likely to get it ?

A

Young patients

Mainly under 35

32
Q

How does HPV cause cervical cancer?

A

HPV takes over the reproductive mechanisms and replicates causing cancer by inhibiting the tumour suppressor gene.

33
Q

What is the most common type of cervical cancer: adenocarcinoma or squamous cell carcinoma?

A

Squamous cell carcinoma

34
Q

Cervical cancer - clinical features

A 
Asymptomatic - presents as a result of screening 
Unusual vaginal discharge 
Abnormal bleeding 
- inter-menstrual
- post coital 
- post menopausal 
Dyspareunia 
Pelvic pain 
Haematuria / urinary infections
35
Q

Cervical cancer tends to cause a pelvic mass. True or false?

A

False

36
Q

Cervical cancer - how many stages are there ?

A

4

37
Q

Cervical cancer - stage I

A

Confined to the cervix
Ia - microscopic
Ib - visible lesion (macroscopic)

38
Q

Cervical cancer - stage II

A

Spread to adjacent organs:
IIa - vaginal involvement
IIb - parametrial involvement

39
Q

Cervical cancer - stage III

A

Involvement of lower vagina or pelvic side wall

40
Q

Cervical cancer - stage IV

A

Infiltration of other organs or distant metastases:
Bladder/rectum involvement
Metastases

41
Q

Cervical cancer - investigations

A

MRI (T2 weighted sequences)

CT scan - to determine metastases

42
Q

Cervical cancer - management if mild/moderate

A

Surgical management
- LLETZ (large loop excision of transformation zone). This aims to remove all the abnormal cells from cervix

  • hysterectomy
43
Q

Cervical cancer - management moderate/severe

A

Surgery +

Radiotherapy

  • damages the DNA in tumour
  • brachytherapy (internal radiation treatment via intra uterine tube)

Chemotherapy
- shrinks tumour

44
Q

Give 3 examples of chemotherapy agents used in cervical cancer treatment

A

Cisplatin
Carboplatin
Paclitaxol

45
Q

What is the most common type of cervical cancer?

A

Squamous cell carcinoma

46
Q

How does squamous cell carcinoma of the cervix develop?

A

From CIN

47
Q

Cervical cancer - grading

A

Well differentiated
Moderately differentiated
Poorly differentiated
Undifferentiated /anaplastic

48
Q

Cervical cancer - local spread

A 
Uterine body 
Vagina 
Bladder 
Ureters 
Rectum
49
Q

Cervical cancer - adenocarcinoma is easier / more difficult to diagnose on a cervical smear than squamous cell carcinoma?

A

More difficult

50
Q

Which is more aggressive:

  • squamous cell carcinoma
  • adenocarcinoma
A

Adenocarcinoma

51
Q

Screening for cervical cancer - aim

A

Reduce incidence of invasive cancer

52
Q

How do you screen for cervical cancer?

A

Cervical smear test

53
Q

Which age group of women get screened?

A

25 -> 64

54
Q

Which age group gets screening every 3 years ?

A

age 25 -> 49

55
Q

Which age group gets screening every 5 years ?

A

Age 50 -> 64

56
Q

Which groups within the eligible population are harder to reach ?

A 
Minority ethnic groups 
Immigrants 
Travellers 
Prisoners 
Students
57
Q

What is the treatment for CIN 1

A

Nothing

Follow up in 1 year

58
Q

Gold standard treatment of CIN

A

LLETZ

  • can examine the whole specimen histologically
  • can confidently rule out cancer
59
Q

CIN what are the 2 treatment options

A

Excision (LLETZ)

Ablation

60
Q

What risk comes along with LLETZ

A

Risk of pre-term labour if not completed family

61
Q

When is test of cure done for patients who have received treatmetn for CIN

A

6 months later

  • test cytology
  • test for HPV
62
Q

test of cure following HPV - double negative result. What do you do ?

A

Patient goes back onto routine recall

63
Q

Test of cure following HPV. either cytology / HPV positive. What do you do

A

recall to Colposcopy

  • abnormal colposcopy - re-treat
  • normal colposcopy - screen yearly for 5 years
64
Q

Name 5 HPV driven cancers

A 
Cervical cancer
Anal cancer 
Oropharyngeal cancer 
Vulval cancer 
Penile cancer
65
Q

Who gets offered the HPV vaccine (3)

A

School girls S2
School boys
MSM through sexual health

66
Q

New guidance on cervical smears from 03/2020 - All HPV +ve woman with ANY grade of dyskaryosis (found on cytology) will be referred for colposcopy. True or false?

A

True

- (even mild dyskaryosis now referred for colposcopy)

67
Q

New guidance on cervical smears from 03/2020 - All HPV +ve woman but with NO cytology abnormality. What is the next step?

A

Screen again in 1 year

68
Q

New guidance on cervical smears from 03/2020 - all samples are FIRST tested for cytology or HPV?

A

HPV

69
Q

COCP and cervical cancer

A

COCP increases risk of developing cancer

70
Q

Cancer involving pelvic wall is stage

A

3

71
Q

Cancer spreading to nearby organs (uterus, vagina) is stage

A

2

72
Q

Cancer involving the rectum or bladder is stage

A

4

73
Q

Which chemotherapy drugs are most commonly used in cervical cancer

A

Cisplatin
Carboplatin
Pacclitaxel

Reproduction SOH (50 decks)

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