CPC cervical cancer Flashcards
what does high risk HPV cause
less common cancers cervix - >99% cases causes by HPV penis vulva/vagina anus mouth oropharynx
how common is cervical cancer
2500 cases p/a in UK
1200 deaths
10th most common cancer in women in scotland
how ‘deadly’ is cervical cancer
good cure rate if detected early
major cause of death in women in low income countries
where is the highest uptake of HPV immunisation
higher income countries
risk factors for cervical cancer
peak age 45-55yrs HPV related (16+18) -75% cases multiple sexual partners early age at first intercourse older age of partner cigarette smoking
most risk factors are related to higher chance of catching HPV infection
why is early age at first intercourse a risk factor for cervical cancer
immature cervix
transformation zone is more susceptible to HPV infections
epidemiology of cervical cancer
most cases are in younger women
incidence rates peak in younger women and older women
more cases in more deprived areas
cervical cancer - red flag symptoms
abnormal vaginal bleeding post coital bleeding intermenstrual bleeding/PMB discharge - brown, smell pain - advanced cancer, unusual presenting symptom
cervical cancer diagnosis
clinical
screen detected - asymptomatic patient is detected through screening
biopsy
what is the aim of cervical screening
detect pre-cancerous disease NOT cancer
histology of cervical cancer - difference between CIN and cancer
tumour cells from epithelium invade into underlying stroma
histology of cervical cancer - types of cancer
majority squamous carcinoma - 80%
adenocarcinoma (endocervical) rising in relative incidence
what is seen here
no clear BM - disrupted by invading cancer cells
dark staining dysplastic cells invading into underlying stroma
what stage is this (no other symptoms at presentation)
what are the substages within this
stage IA - invasive cancer identified only microscopically
IA1 - ≤3mm depth and ≤7mm diameter (microinvasive)
IA2 - ≤5mm x7mm (increased risk of pelvic LN involvement)
what are stage IB tumours
clinical tumours confined to the cervix
local spread of cervical cancer
stage 2 - upper 2/3 vagina
stage 3 - lower vagina, pelvis
stage 4 - bladder, rectum
spread of cervical cancer - mets
lymphatic - pelvic nodes, more advanced disease can spread via para-aortic nodes
blood - liver, lungs, bone
cervical cancer staging
PET-CT
MRI
cervical cancer treatment - stages I-II
IA1 - type 3 excision of the cervical TZ or hysterectomy
IB-IIA - radical hysterectomy or chemo-radiotherapy
IIB-1V - chemo-radiotherapy
what is a radical hysterectomy
exploration of pelvic and para-aortic space
removal of: uterus, cervix, upper vagina; parametria; pelvic nodes
ovaries conserved in pre-menopausal women
what type of RT is used for cervical cancer
external beam
what is the schedule of chemotherapy for cervical cancer
once weekly during radiotherapy
what is brachytherapy
follows of chemo-RT
caesium insertion to site of tumour for 24hrs
