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OBS & GYNAE (Obstetrics & Gynaecology) > Gynaecological Oncology & Screening - Cervical Cancer > Flashcards

Gynaecological Oncology & Screening - Cervical Cancer Flashcards

1
Q

Histology of Cervix (3).

A
  1. Endocervix : Columnar Epithelium.
  2. Ectocervix : Squamous Epithelium.
  3. Meeting : Squamous-Columnar Junction.
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2
Q

What happens in the Cervix during Puberty and Pregnancy?

A

Hormonally-Induced Eversion : lower pH of the vagina results in the formation of a physiological Transformation Zone (TZ) - columnar epithelium undergoes physiological metaplasia to become squamous epithelium.

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3
Q

Types of Cervical Cancer (2).

A
  1. 80% - Invasive SCC (from CIN).

2. 20% - Adenocarcinoma (from CGIN - Glandular).

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4
Q

Main Risk Factors of Cervical Cancer (3).

A
  1. Increased Risk of Catching HPV.
  2. Non-Engagement with Screening (Late Detection of Precancerous and Cancerous Changes).
  3. Lifestyle Factors.
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5
Q

What can cause an Increased Risk of Catching HPV? (4)

A
  1. Early Sexual Activity.
  2. Increased Number of Sexual Partners.
  3. Sexual Partners With More Partners.
  4. Not Using Condoms.
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6
Q

Lifestyle Factors (6).

A
  1. Smoking.
  2. HIV.
  3. COCP for 5+ Years.
  4. Increased Number of Full-Term Pregnancies.
  5. Family History.
  6. Exposure to Diethylstilbestrol during Foetal Development (a drug used before 1971).
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7
Q

Epidemiology of HPV.

A
  1. Commonest Cause of Cervical Cancer.
  2. 100+ Strains - Type 16 and 18 : Cervical Cancer.’
  3. Resolve within 2 years spontaneously usually.
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8
Q

Pathophysiology of HPV Infection and Cervical Cancer (2).

A
  1. p53 and pRb are tumour suppressor genes.

2. HPV produces E6 and E7 proteins which inhibit these tumour suppressor genes (E6 - p53; E7 - pRb).

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9
Q

HPV Vaccine (4).

A
  1. Given to Boys and Girls BEFORE becoming sexually active.
  2. Current NHS Vaccine : Gardasil.
  3. 6 and 11 : Genital Warts.
  4. 16 and 18 and 33 : Cervical Cancer.
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10
Q

How do Infected Endocervical Cells appear under a microscope?

A

Koilocytes :

  1. Enlarged Nucleus.
  2. Irregular Nuclear Membrane Contour.
  3. Hyperchromasia : Nucleus Stains Darker than Normal.
  4. Perinuclear Halo.
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11
Q

What is CIN?

A

Cervical Intrapeithelial Neoplasia - dysplasia (premalignant change) in the cells of the cervix - a diagnosis at colposcopy.

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12
Q

Grading of CIN (3).

A
  1. CIN I : Mild Dysplasia (1/3 of Thickness of Epithelial Layer - likely to return to normal without treatment).
  2. CIN II : Moderate Dysplasia (2/3 of Thickness of Epithelial Layer - likely to progress to cancer without treatment).
  3. CIN III (Cervical CIS) : Severe Dysplasia - very likely to progress to cancer without treatment.
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13
Q

Management of CIN.

A
  1. CIN I : Observation and Follow-Up.

2. CIN II/III - LLETZ.

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14
Q

Clinical Presentation of Cervical Cancer (6).

A
  1. Asymptomatic.
  2. Abnormal Vaginal Bleeding - Intermenstrual, Postcoital, Postmenopausal.
  3. Vaginal Discharge.
  4. Pelvic Pain.
  5. Dyspareunia.
  6. Constitutional Symptoms.
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15
Q

What is the Rule of Thumb with Cervical Cancer?

A

Post-Coital Bleeding is due to Cervical Cancer until proven otherwise.

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16
Q

Examination of Cervical Cancer.

A
  1. Swab - Infection.

2. Abnormal Appearance : Ulceration, Inflammation, Bleeding, Visible Tumour.

17
Q

Staging of Cervical Cancer (4).

A

FIGO System :

  1. Confined to Cervix.
  2. Invades Uterus/Upper 2/3 of Vagina.
  3. Invades Pelvic Wall/Lower 1/3 of Vagina.
  4. Invades Bladder, Rectum, Beyond Pelvis.
18
Q

Cervical Screening Recommendations.

A
  1. Don’t use unscheduled cervical screening with a smear test.
  2. Don’t use the result of cervical screening to exclude cervical cancer where it is suspected for another reason, even if the smear result was normal.
19
Q

Aim of Cervical Screening.

A

Pick up precancerous changes in the epithelial cells of the cervix.

20
Q

Method of Cervical Screening (2).

A
  1. Cervical Smear Test - speculum examination and collection of cells from the cervix using a small brush.
  2. The cells are deposited into preservation fluid and transported to a lab (liquid-based cytology) for microscopy to check for dyskaryosis.
21
Q

What are the Samples tested for? (2)

A
  1. High-Risk HPV.

2. Cell Examination (only if HPV is Positive).

22
Q

Routine of Cervical Screening Program (7).

A
  1. Every 3 Years Between 25-49.
  2. Every 5 Years Between 50-64.
  3. Annually - HIV.
  4. 65+ Can Request Smear if None Since 50.
  5. Additional Tests (e.g. Tests of Cure) if Previous CIN.
  6. Additional Screening if Immunocompromised.
  7. Routine Smear for Pregnancy - Wait 12 Weeks Post-Partum.
23
Q

Cytology Results (8).

A
  1. Inadequate.
  2. Normal.
  3. Borderline Changes.
  4. Low-Grade Dyskaryosis.
  5. High-Grade (Moderate) Dyskaryosis.
  6. High-Grade (Severe) Dyskaryosis.
  7. Possible Invasive SCC.
  8. Possible Glandular Neoplasia.
24
Q

Additional Findings in Cervical Smear Results (2).

A
  1. Infections.

2. ALO - IUD Coil (only remove coil if symptomatic).

25
Q

Management of Smear Results (4).

A

PHE Guidelines :

  1. Inadequate Sample - Repeat After at least 3 Months. If 2 Consecutive Inadequate Samples - Colposcopy.
  2. HPV Negative - Continue Routine Screening.
  3. HPV Positive + Normal Cytology - Repeat HPV Test after 12 Months.
  4. HPV Positive + Abnormal Cytology - Refer for Colposcopy.
26
Q

When is the best time for a woman to take a cervical smear?

A

Mid-cycle.

27
Q

What is Colposcopy?

A

Insertion of a Speculum and Colposcope to magnify the cervix to examine the epithelial lining of the cervix.

28
Q

Stains in Colposcopy (2).

A
  1. Acetic Acid : Acetowhite Appearance (White) in Cells with Increased Nuclear : Cytoplasmic Ratio e.g. CIN, Cancer.
  2. Schiller’s Iodine Test : Healthy cells stain brown; abnormal cells do not.
29
Q

Management of Cervical Cancer (6).

A
  1. CIN/Early-Stage (1A) : LLETZ or Cone Biopsy.
  2. 1B-2A : Radical Hysterectomy and Removal of Local Lymph Nodes with Chemotherapy and Radiotherapy.
  3. 2B-4A : Chemotherapy and Radiotherapy.
  4. 4B : Surgery, Radiotherapy, Chemotherapy and Palliative Care.
  5. Pelvic Exenteration.
  6. Bevacizumab (Avastin).
30
Q

What is LLETZ?

A

Large Loop Excision of the Transformation Zone (Loop Biopsy) with Local Anaesthetic during Colposcopy.

31
Q

What happens in LLETZ?

A
  1. Loop of wire with electrical current (diathermy) is used to remove abnormal epithelial tissue on the cervix.
  2. Diathermy cauterises the tissue and stops the bleeding.
32
Q

Post-LLETZ Considerations.

A
  1. Bleeding and Abnormal Discharge can occur for several weeks following LLETZ.
  2. Avoid intercourse and tampon use to reduce risk of infection.
  3. Increased risk of preterm labour, based on depth of tissue removed.
33
Q

What is a Cone Biopsy?

A

A cone-shaped piece of the cervix is removed in surgery under general anaesthetic as treatment for CIN or early-stage Cervical Cancer to be sent for histology.

34
Q

Risks of Cone Biopsy (5).

A
  1. Pain.
  2. Infection.
  3. Bleeding.
  4. Scar Formation : Stenosis of Cervix.
  5. Increased Risk of Miscarriage and Premature Labour.
35
Q

What is Pelvic Exenteration?

A

An operation in advanced cervical cancer, removing most/all pelvic organs.

36
Q

What is Bevacizumab/Avastin?

A

Monoclonal antibody to treat metastatic/recurrent cervical cancer by targeting VEGF-A.

OBS & GYNAE (Obstetrics & Gynaecology) (73 decks)

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