Gynaecological cancer Flashcards
What are the cell types of cervical cancer?
80% squamous cell carcinoma
next MC is adenocarcinoma
what cancer is HPV associated with?
cervical
anal, vulval, vaginal, penis, mouth and throat cancers
what are the 2 important strains of HPV?
type 16 and 18, vaccine targets them
cause 70% of cervical cancer
what is the pathophysiology of HPV causing cervical cancer?
P53 and pRb are tumour suppressor genes.
HPV (types 16 and 18) produces two proteins (E6 and E7) that inhibit these tumour suppressor genes.
The E6 protein inhibits p53
E7 protein inhibits pRb. Therefore, HPV promotes the development of cancer by inhibiting tumour suppressor genes.
less common risk factors of cervical cancer?
Smoking
HIV (patients with HIV are offered yearly smear tests)
Combined contraceptive pill use for more than five years
Increased number of full-term pregnancies
Family history
Exposure to diethylstilbestrol during fetal development (this was previously used to prevent miscarriages before 1971)
what appearance of the cervix makes you think cancer?
Ulceration Inflammation Bleeding Visible tumour --> urgent refer for colposcopy
How do you diagnose CIN?
Cervical intraepithelial neoplasia (CIN) is a grading system for the level of dysplasia (premalignant change) in the cells of the cervix. CIN is diagnosed at colposcopy (not with cervical screening)
TOM TIP: Try not to get mixed up between dysplasia found during colposcopy and dyskaryosis on smear results.
3 grades of CIN
CIN I: mild dysplasia, affecting 1/3 the thickness of the epithelial layer, likely to return to normal without treatment
CIN II: moderate dysplasia, affecting 2/3 the thickness of the epithelial layer, likely to progress to cancer if untreated
CIN III: severe dysplasia, very likely to progress to cancer if untreated
CIN III is sometimes called cervical carcinoma in situ.
How often do you screen for cervical cancer? what are the exceptions?
Every three years aged 25 - 49
Every five years aged 50 - 64
Women with HIV are screened annually
Women over 65 may request a smear if they have not had one since aged 50
Women with previous CIN may require additional tests (e.g. test of cure after treatment)
Certain groups of immunocompromised women may have additional screening (e.g. women on dialysis, cytotoxic drugs or undergoing an organ transplant)
Pregnant women due a routine smear should wait until 12 weeks post-partum
what can the cytology results from cervical smear show?
Inadequate Normal Borderline changes Low-grade dyskaryosis High-grade dyskaryosis (moderate) High-grade dyskaryosis (severe) Possible invasive squamous cell carcinoma Possible glandular neoplasia
infections may be identified
what organism is discovered in women with the coil?
Actinomyces-like organisms are often discovered in women with an intrauterine device (coil). These do not require treatment unless they are symptomatic. Where the woman is symptomatic (e.g. pelvic pain or abnormal bleeding), removal of the intrauterine device may be considered.
What is Colposcopy?
It involves inserting a speculum and using equipment (a colposcope) to magnify the cervix. This allows the epithelial lining of the cervix to be examined in detail. During colposcopy, stains such as acetic acid and iodine solution can be used to differentiate abnormal areas.
A punch biopsy or large loop excision of the transformational zone can be performed during the colposcopy procedure to get a tissue sample.
what does acetic acid and iodine do on colposcopy?
Acetic acid causes abnormal cells to appear white = acetowhite.
–> This occurs in cells with an increased nuclear to cytoplasmic ratio (CIN, cancer)
Schiller’s iodine test involves using an iodine solution to stain the cells of the cervix. Iodine will stain healthy cells a brown colour. Abnormal areas will not stain.
What is a LLETZ procedure?
A large loop excision of the transformation zone aka a loop biopsy.
- under LA on colposcopy
- use a loop of wire with electrical current (diathermy) to remove abnormal epithelial tissue on the cervix. The electrical current cauterises the tissue and stops bleeding.
Bleeding and abnormal discharge can occur for several weeks following a LLETZ procedure. This varies between women. Intercourse and tampon use should be avoided after the procedure to reduce the risk of infection. Depending on the depth of the tissue removed from the cervix, the procedure may increase the risk of preterm labour.
what obstetric complication can occur after a LLETZ procedure?
preterm labour - depend son depth of tissue removed
What is a cone biopsy used for?
treatment forCIN and very early-stage cervical cancer.
- under GA
The surgeon removes a cone-shaped piece of the cervix using a scalpel. This sample is sent for histology to assess for malignancy.
Main risks of a cone biopsy
Pain
Bleeding
Infection
Scar formation with stenosis of the cervix
Increased risk of miscarriage and premature labour
what staging is used for cervical cancer?
The International Federation of Gynaecology and Obstetrics (FIGO) staging system is used to stage cervical cancer:
Stage 1: Confined to the cervix
Stage 2: Invades the uterus or upper 2/3 of the vagina
Stage 3: Invades the pelvic wall or lower 1/3 of the vagina
Stage 4: Invades the bladder, rectum or beyond the pelvis
