Gynaecological Oncology Flashcards
Which HPV subtypes are most commonly associated with cancer?
16 and 18
Which HPV subtypes are most commonly associated with genital warts?
6 and 11
How is HPV transmitted?
Skin to skin contact
Who gets HPV vaccine?
All girls aged 12-13 - three injections over 12 months
How often is cervical screening done?
25-49 = every 3 years 50-64 = every 5 years
How is cervical screening done?
Liquid based cytology
Plastic broom swept over the transformation zone aiming to remove thin layer of cells. This is placed in liquid transport medium to be examined microscopically for any cells with dyskaryotic features. HPV test also done.
What does high-grade dyskaryosis mean?
Reduced ratio of nucleus to cytoplasm
What is colposcopy?
Examination of cervix with bright light and magnification to identify any abnormal areas – cervical intraepithelial neoplasia (CIN I, II and III)
What is done and identified in colposcopy?
Whole transformation zone should be identified.
o 5% Acetic acid – CIN cells appear white – these areas biopsied.
o Lugol’s solution – Schiller’s test – less well taken up by CIN cells
o Abnormal capillary patterns- punctuation, mosaicism
What action is taken if borderline/mild dyskaryosis is found at smear
HPV test
if +ve –> colposcopy
if -ve –> normal recall
What action is taken if moderate or severe dyskaryosis is found at smear
Straight to colposcopy
Definition of CIN I, II and III?
I = dyskaryosis 1/3 thickness of cervix II = dyskaryosis 2/3 thickness of cervix III = dyskaryosis full thickness of cervix
How is CIN managed?
I = Treatment vs no treatment
II/III = LLETZ – large loop excision of the transformation zone. Mostly performed in clinic under local anaesthesia
Most common types of cervical cancer?
Squamous cell carcinomas or adenocarcinomas
Features of cervical cancer?
- Post-coital bleeding, inter-menstrual bleeding and postmenopausal bleeding
- Persistent, offensive, blood-stained discharge
- Pain in late disease - loin (obstructed ureter), buttock and back- metastatic (compression by mass)
- Swollen leg- thrombosis in the pelvis
Examination in cervical cancer?
- Speculum examination
- Bimanual examination
- PR
Investigations in cervical cancer?
- Colposcopy
- Cervical biopsy
- FBC, U&Es, LFTs
- MRI pelvis
- CT abdomen and chest (or CXR)
Direct/local spread of cervical cancer?
Vagina, bladder, parametrium, bowel
Lymphatic spread of cervical cancer?
Parametrial nodes, internal, external and common illiac nodes, obturator nodes, pre-sacral, para-aortic nodes
Bloodborne spread of cervical cancer?
Lungs, liver