Gynae: Cervical Cancer Flashcards
what age group is most commonly affected by cervical cancer?
younger women, of reproductive age
what is the most common type of cervical cancer?
most common (80%) is squamous cell next most common is adenocarcinoma
what virus are children aged 12-13 vaccinated against that is strongly associated with cervical cancer?
Human Papilloma Virus (HPV)
What cancers (other than cervical) is HPV associated with?
anal, vulval, vaginal, penis, mouth and throat
which strains of HPV are most commonly associated with cervical cancer?
type 16 and 18
explain the link between HPV type 16 and 18 and tumour suppressor genes?
HPV produces 2 proteins which target 2 tumour suppressor genes inhibiting their suppression therefore promoting the development of cancer
E6 inhibits P53
E7 inhibits pRb
What are the risk factors for cervical cancer? Think of increased risk of catching HPV, later detection and other risks
- Increased risk = early sexual activity, increased number of sexual partners, sexual partners who have had multiple partners, not using protection
- Non-engagement with cervical screening - many cases are preventable with early detection
- Others = smoking, HIV, COCP, increased number of full-term pregnancies, FHx, exposure to diethylstilbestrol during fetal development
What are the presenting symptoms of cervical cancer?
Usually asymptomatic
Abnormal vaginal bleeding
Vaginal discharge
Pelvic pain
Dyspareunia
what is NICE CKS 2017 guidance on smears in the context of cervical cancer?
Recommend against unscheduled cervical screening with a smear test
Also advise against using results of cervical screening to exclude cancer where it is suspected for another reason
for cervical cancer, symptoms are non-specific so a speculum examination is done. what may be seen on speculum exam that could indicate cervical cancer?
Ulceration
Inflammation
Bleeding
Visible tumour
when the appearance of the cervix is abnormal and suggestive of cervical cancer, what are patients urgently referred for and what is it?
colposcopy - using a colposcope to magnify the cervix allowing the epithelial lining to be examined in detail/ acetic acid and iodine solution can be used to differentiate abnormal areas. a punch biopsy or large loop excision of the transformation zone can be performed during colposcopy
what are the 2 stains used during colposcopy and what do they show?
- *acetic acid** - causes abnormal cells to appear white (described as acetowhite) occurs in cells with an increased nuclear to cytoplasmic ratio (cervical intraepithelial neoplasia and cervical cancer cells)
- *schiller’s iodine test** - uses iodine to stain healthy cells. unhealthy cells will not stain
what is CIN? And when is it diagnosed?
Cervical Intraepithelial Neoplasia
a grading system for the level of dysplasia in the cells of the cervix. diagnosed at colposcopy NOT cervical screening
what are the grades of CIN?
CIN I = mild dysplasia affecting 1/3 of the thickness of the epithelial layer - likely to return to normal without treatment
CIN II = moderate dysplasia affecting 2/3 of thickness of epithelial layer, likely to progress to cancer if untreated
CIN III = severe dysplasia very likely to progress to cancer if intreated
what is cervical screening?
way of picking up precancerous changes in epithelial cells of the cervix.
involves a smear test whereby cells are collected from the cervix with a small brush during a speculum exam.
cells transferred to preservation fluid and examined under microscope for precancerous changes called dyskaryosis
What are the cytology results for cervical screening?
- Inadequate
- Normal
- Borderline changes
- Low-grade dyskaryosis
- High-grade dyskaryosis (moderate)
- High-grade dyskaryosis (severe)
- Possible invasive squamous cell carcinoma
- Possible glandular neoplasia
how is cervical cancer staged?
International Federation of Gynaecology and Obstetrics
stage 1 = confined to cervix
stage 2 = invades the uterus or upper ⅔ of vagina
stage 3 = invades pelvic wall or lower ⅓ of vagina
stage 4 = invades bladder, rectum or beyond pelvis
how is cervical cancer managed?
- CIN and early-stage 1A: LLETZ or cone biopsy
- Stage 1B – 2A: Radical hysterectomy and removal of local lymph nodes with chemotherapy and radiotherapy
- Stage 2B – 4A: Chemotherapy and radiotherapy
- Stage 4B: Management may involve a combination of surgery, radiotherapy, chemotherapy and palliative care
