Gynae Cancers Flashcards
What is the cervical screening programme?
- 25-49: 3 yearly smears
* 50-65: 5 yearly smears
DD for abnormal smear?
- infection/inflammation (if suspected, swabs should be obtained)
- Dyskaryosis
- Malignancy
What is Mild Dyskaryosis and what happens next?
- Low grade lesion, perform colposcopy only if test positive for HPV
- negative goes to routine recall
How common are adenocarcinomas and what is the problem with them?
Not detected by smear, account for 15-20%
When is the best time to do a smear? How is it done?
Recommend midcycle
Move away from pap smears to liquid based cytology
What are the HPV subtypes that are high risk for causing Ca
16,18,33
What is Mod Dyskaryosis and what happens next?
Consistant with CIN II
refer for colposcopy
What is severe Dyskaryosis and what happens next?
Consistant with CIN III
2 week wait
What is done with an inadequate smear?
Repeat, if 3 inadequate then refer for colposcopy
Epidemiology of cervical cancer?
- 50% are under 45
- highest incidence 25-9
- 80% squamous cell cancer
What are the features of cervical cancer?
- may be detected during routine cervical cancer screening
- abnormal vaginal bleeding: postcoital, intermenstrual or postmenopausal bleeding
- vaginal discharge
Risk factors for cervical cancer?
- smoking
- HIV
- Early first intercourse, multiple partners
- high parity
- lower SE status
- COCP (confirmed in lancet study 2007)
How does HPV cause cervical cancer?
- HPV 16 & 18 produces the oncogenes E6 and E7 genes respectively
- E6 inhibits the p53 tumour suppressor gene
- E7 inhibits RB suppressor gene
How does the vaccination programme work for cervical cancer?
•Offered from 2008 onwards
•Girls aged 13 and above
o 3 x vaccination at 6 monthly intervals
o Guardasil – protects against HPV 6, 11, 16, 18
DD of Post coital bleeding or intermenstrual bleeding?
- cervical ectropion
- infection
- polyps
- malignancy
- progesterone only pill
- acute/chronic cervicitis
