Gynae oncology Flashcards
What is the appearance of a normal cervix after puberty?
-Columnar tissue at centre of ectocervical surface (= ectopy)
-Squamous epithelium surrounding it
-Transformation zone between the two where columnar cells transform to squamous (ie squamous metaplasia)
What is a cervical ectropion?
-Endocervical epithelium extends into ectocervix
-Prone to bleeding and infection but often asymptomatic
-Cauterise if necessary
When are cervical smears offered to people with a cervix?
-Every 3 years for those aged 25-49
-Every 5 years for those aged 50-64
(Those with HIV are screened annually due to increased risk)
What are cervical smear samples assessed for?
-Dyskaryosis (precancerous changes)
-Tested for HPV
NB CIN grading is only done after colposcopy
What different steps are taken following smear results?
-Inadequate sample –> repeat in 3 months
-Normal cytology but HPV positive –> repeat HPV in 12 months
-Borderline / mild dyskaryosis –> test for high-risk HPV
–If negative –> continue routine screening
–If positive –> colposcopy referral
-Moderate dyskaryosis –> refer for urgent colposcopy
-Severe dyskaryosis –> refer for urgent colposcopy
-Suspected invasive carcinoma –> refer for urgent colposcopy
What does a colposcopy involve?
-Visualisation / magnification of the cervix
-Iodine solution and acetic acid stains used to visualise abnormal areas
What does the CIN staging denote?
Grading system for the level of dysplasia in cervical intraepithelial dysplasia
CIN I = mild dysplasia, affecting 1/3 of the thickness of the epithelial layer, likely to self-resolve
CIN II = moderate dysplasia, affecting 2/3 of the thickness of the epithelial layer, likely to progress to cancer if left untreated
CIN III = severe dysplasia, very likely to progress to cancer
–aka cervical carcinoma in situ
What does the FIGO staging for cervical cancer denote?
Stages the level of spread of cervical cancer
Stage 1 = confined to cervix
Stage 2 = invades uterus / upper 2/3 of vagina
Stage 3 = invades pelvic wall / lower 1/3 of vagina
Stage 4 = invades bladder, rectum or beyond pelvis
What are the different management options for different stages of cervical cancer?
CIN and early stage 1 = LLETZ or cone biopsy
Stage 1-2 = radical hysterectomy and lymphadenectomy, chemo + RT
Stage 2-4 = chemo + RT
Stage 4 (late) = surgery, chemo, RT and palliative
What is the difference between a LLETZ and a cone biopsy?
Large Loop Excision of the Transformation Zone
-Removal of abnormal epithelial tissue during colposcopy
-Done under LA
Cone biopsy
-Used to treat CIN and early stage 1 cancer
-Done under GA
-Removal of cone-shaped piece of cervix using scalpel
What are the high-risk HPV types?
16, 18, 31, 33
(6 + 11 cause genital warts)
How does cervical cancer present?
-Irregular smear
-Post-coital bleeding
-IMB / PMB
-Menorrhagia
-Abnormal discharge (often blood-stained)
-Pain (late sign)
How does the unopposed oestrogen hypothesis relate to endometrial cancer?
-Increased oestrogen exposure induces endometrial hyperplasia –> malignant change
-Greater life-time exposure = greater risk
-NB unopposed oestrogen = oestrogen without progesterone
What risk factors are there for endometrial cancer?
-Increasing age (>45)
-Nulliparity
-Early menarche and late menopause
-Obesity (peripheral conversion of androgens to oestrogen)
-HRT
-Tamoxifen therapy
-Chronic anovulation
What protective factors are there for endometrial cancer?
-Smoking
-Pregnancy
-Diet and exercise
-IUS, COCP, early menopause
