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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
What is CIN ?
Pre-invasive stage of squamous cervical carcinoma
26
What is CGIN
Pre-invasive stage of endocervical adenocarcinoma
27
What is VIN?
Vulvar intraepithelial neoplasia | Often HPV related
28
Who gets VIN?
Often extremes of age
29
VIN is linked to which condition?
Pagets disease
30
Pagets disease - histopathology
Large malignant cells look like balloons that are going through the epidermis
31
Cervial cancer - which age range is likely to get it ?
Young patients | Mainly under 35
32
How does HPV cause cervical cancer?
HPV takes over the reproductive mechanisms and replicates causing cancer by inhibiting the tumour suppressor gene.
33
What is the most common type of cervical cancer: adenocarcinoma or squamous cell carcinoma?
Squamous cell carcinoma
34
Cervical cancer - clinical features
``` 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
Cervical cancer tends to cause a pelvic mass. True or false?
False
36
Cervical cancer - how many stages are there ?
4
37
Cervical cancer - stage I
Confined to the cervix Ia - microscopic Ib - visible lesion (macroscopic)
38
Cervical cancer - stage II
Spread to adjacent organs: IIa - vaginal involvement IIb - parametrial involvement
39
Cervical cancer - stage III
Involvement of lower vagina or pelvic side wall
40
Cervical cancer - stage IV
Infiltration of other organs or distant metastases: Bladder/rectum involvement Metastases
41
Cervical cancer - investigations
MRI (T2 weighted sequences) | CT scan - to determine metastases
42
Cervical cancer - management if mild/moderate
Surgical management - LLETZ (large loop excision of transformation zone). This aims to remove all the abnormal cells from cervix - hysterectomy
43
Cervical cancer - management moderate/severe
Surgery + Radiotherapy - damages the DNA in tumour - brachytherapy (internal radiation treatment via intra uterine tube) Chemotherapy - shrinks tumour
44
Give 3 examples of chemotherapy agents used in cervical cancer treatment
Cisplatin Carboplatin Paclitaxol
45
What is the most common type of cervical cancer?
Squamous cell carcinoma
46
How does squamous cell carcinoma of the cervix develop?
From CIN
47
Cervical cancer - grading
Well differentiated Moderately differentiated Poorly differentiated Undifferentiated /anaplastic
48
Cervical cancer - local spread
``` Uterine body Vagina Bladder Ureters Rectum ```
49
Cervical cancer - adenocarcinoma is easier / more difficult to diagnose on a cervical smear than squamous cell carcinoma?
More difficult
50
Which is more aggressive: - squamous cell carcinoma - adenocarcinoma
Adenocarcinoma
51
Screening for cervical cancer - aim
Reduce incidence of invasive cancer
52
How do you screen for cervical cancer?
Cervical smear test
53
Which age group of women get screened?
25 -> 64
54
Which age group gets screening every 3 years ?
age 25 -> 49
55
Which age group gets screening every 5 years ?
Age 50 -> 64
56
Which groups within the eligible population are harder to reach ?
``` Minority ethnic groups Immigrants Travellers Prisoners Students ```
57
What is the treatment for CIN 1
Nothing | Follow up in 1 year
58
Gold standard treatment of CIN
LLETZ - can examine the whole specimen histologically - can confidently rule out cancer
59
CIN what are the 2 treatment options
Excision (LLETZ) | Ablation
60
What risk comes along with LLETZ
Risk of pre-term labour if not completed family
61
When is test of cure done for patients who have received treatmetn for CIN
6 months later - test cytology - test for HPV
62
test of cure following HPV - double negative result. What do you do ?
Patient goes back onto routine recall
63
Test of cure following HPV. either cytology / HPV positive. What do you do
recall to Colposcopy - abnormal colposcopy - re-treat - normal colposcopy - screen yearly for 5 years
64
Name 5 HPV driven cancers
``` Cervical cancer Anal cancer Oropharyngeal cancer Vulval cancer Penile cancer ```
65
Who gets offered the HPV vaccine (3)
School girls S2 School boys MSM through sexual health
66
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?
True | - (even mild dyskaryosis now referred for colposcopy)
67
New guidance on cervical smears from 03/2020 - All HPV +ve woman but with NO cytology abnormality. What is the next step?
Screen again in 1 year
68
New guidance on cervical smears from 03/2020 - all samples are FIRST tested for cytology or HPV?
HPV
69
COCP and cervical cancer
COCP increases risk of developing cancer
70
Cancer involving pelvic wall is stage
3
71
Cancer spreading to nearby organs (uterus, vagina) is stage
2
72
Cancer involving the rectum or bladder is stage
4
73
Which chemotherapy drugs are most commonly used in cervical cancer
Cisplatin Carboplatin Pacclitaxel

Reproduction SOH (50 decks)

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