HPV, CIN and cervical cancer Flashcards
physiological changes to cervix: pre pub - pub - post pub
pre pub: endocervical canal: columnar and cervix: squamous
puberty: squamous columnar junction (SCJ) migrates down - columnar exposure to acidic pH
gives - TRANSFORMATION ZONE from squamous metaplasia called a physiological ectopy/ectocervix
HPV RFs
age 25-35yo multiple sexual partners early age of starting sex smoking immunosuppressants giving birth early, <16yo
increase in HPV related anal cancers - male on male
HPV virus
DNA virus - infects squamous epithelium
- high risk: 16,18
- genital warts: 6, 11
HPV vaccine
quadrivalent - 3 vaccines, 3 injections, 6 months - 16 ,18, 6, 11
CIN?
persistent HPV infection (16,18) - esp transformation zone (vulnerable) - can lead to CERVICAL INTRAEPITHELIAL NEOPLASIA - pre malignant
staging of CIN
CIN 1 - mild, 1/3 of epi
CIN 2 - moderate, 2/3rds
CIN 3 - precursor to invasive cancer
cervical screening routine
LBC - liquid based cytology
25-65yo
25-50yo: every 3 yrs
50-65yo: every 5 yrs
CIN investigations
screening
colposcopy: PUNCH BIOPSY
- acetic acid
- iodine
for cancer cells
CIN tx
LLETZ = large loop excision of transformation zone
> 10mm excision increased risk of pre term labour
cervical cancer - prognosis + aetiology
much rarer than endo and ovarian cancers - but much poor prognosis
peak age range of cervical
45-55yo
RFs for cervical cancer
same as HPV
- early age of sexual intercourse
- multiple partners
- HPV infection
- frequency of intercourse
results of smear
SIL - squamous intraepithelial lesion
low or high grade
low - repeat after 6 months then colposcopy
high - refer for colposcopy
tests on cervical cancer
histology: commonly squamous carcinoma
molecular test (PCR) for type of HPV infection - DNA, RNA from LBC
pc symptoms for cervical cancer
asymptomatic: contact bleeding
more advanced:
PMB, IMB, PCB
most advanced: mets symptoms
