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Biology of Cancer > Human Papilloma viruses and Cervical cancer > Flashcards

Human Papilloma viruses and Cervical cancer Flashcards

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1
Q

What is cervical cancer?

A

Cancer that is found anywhere within the cervix

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2
Q

How many women are diagnosed with cervical cancer?

A
  • 2800/year in UK
  • 500,000/year worldwide
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3
Q

What is the mortality rate of cervical cancer?

A

1000 per year

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4
Q

What is the demographic for cervical cancer?

A

Sexually active women aged 25-45

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5
Q

What are the 2 types of cervical cancer?

A

Squamous cell and Adenocarcinoma

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6
Q

What is squamous cell cervical cancer?

A
  • cancer found in squamous cells which are surface cells of the cervix
  • most common type (80%)
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7
Q

What is adenocarcinoma cervical cancer?

A
  • cancer found in the mucus-producing glands within the endocervix
  • less common
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8
Q

How is cervical cancer detected?

A
  • Screening is used to detect precancerous cellular anomalies (dysplasia)
  • reduced incidence by effective treatment/surgery
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9
Q

What is the survival rate of cervical cancer?

A
  • depends on its stage and the patient’s age
  • 5+ year survival = 95% stage l, 15% stage lV
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10
Q

What are symptoms of early cervical cancer?

A
  • usually little/no symptoms
  • Unusual bleeding
  • unusual discharge
  • pain
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11
Q

What are symptoms of advance cervical cancer?

A
  • haematuria
  • constipation
  • bone pain
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12
Q

What is cervical intraepithelial neoplasia (CIN)?

A
  • a precancerous viral condition caused by HPV (16/18) that produces potentially malignant lesions
  • shows changes in the cervical cells which can be detected with screening
  • can be treated successfully
  • almost all women with cervical cancer have been infected with the virus
  • Spread through sexual intercourse
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13
Q

What are causes/risk factors of cervical cancer?

A
  • infection with HPV (16/18)
  • infection with other sexually transmitted diseases (chlamydia/HIV) that weaken the immune system
  • smoking
  • contraceptive pill
  • no regular screening
  • IDEA THAT THERE IS AN INFECTIOUS AGENT INVOLVED BUT NOT IDENTIFIED
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14
Q

How is cervical cancer diagnosed?

A
  • abnormal cervical smear test that is offered to women aged 25-64 to detect CIN
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15
Q

What vaccinations are there for cervical cancer?

A
  1. Gardasil - HPV 16/18/6/11
  2. Cervarix - HPV 16/18
    - must be given before exposure: <12 yrs for girls, unknown for boys
    - effective for at least 6 years
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16
Q

What further tests are done if the smear test is abnormal?

A
  • Colposcopy = microscope used to look directly at the cervix to detect any dysplastic cells
  • Biopsy = for microscopic examination for cancer
  • MRI, PET scan, X-ray
17
Q

What happens to the arrangement of the cervical cells as cancer progresses?

A
  • cells start in a normal arrangement but as CIN progresses the tissue becomes more disorganised and eventually there is a large increase in cells resulting in invasive cancer
  • the changes start in the basal cell layers and then go through to encompass the entire epithelium
18
Q

What are treatments for cervical cancer?

A
  • pathology, stage, curative/palliative, patient factors all need to be taken into account
    1. Local surgical excision
    2. Hysterectomy
    3. Radiotherapy
    4. Chemotherapy
19
Q

What are the different stages of cervical cancer?

A
  1. Stage l - carcinoma confined to cervix
  2. Stage lA - invasive cancer identified only microscopically
  3. Stage lB - clinical lesion confined to cervix
  4. Stage ll - cancer extends beyond cervix but not to pelvic wall
  5. Stage lll - cancer has extended on to pelvic sidewall
20
Q

How does HPV cause cancer?

A
  • several HPV types can produce malignant lesions which have potential to be malignant and cause common carcinoma of the uterine cervix
21
Q

What are human papilloma viruses (HPVs)?

A
  • large group (approx 100) of small DNA tumour viruses
  • infect cutaneous and mucosal epithelial tissue
  • Usually give benign hyperplasia/warts that regress spontaneously
22
Q

How do DNA tumour viruses cause cancer?

A
  • have cancer causing mechanisms
  • encode oncoproteins using host cells which are distinct from their proteins
  • viral oncoproteins inactivate tumour suppressor proteins resulting in uncontrollable growth
23
Q

What are the high and low risk cancer types of HPV?

A
  • High risk = HPV16/18, found in 95% cases
  • Low risk = HPV6/11, usually benign
24
Q

What is the latency period of HPV?

A
  • first developed in sexually active 15-25yrs old then seen in 40-50yrs old when a carcinoma becomes visible
25
Q

What are characteristics of the HPV genome?

A
  • difficult to culture
  • replication depends on host cell proliferation
26
Q

What are characteristics of HPV malignant cells?

A
  • partial HPV sequences
  • intergrated into host DNA
  • E2 open reading frame usually disrupted
  • deregulation of E6/E7 region
27
Q

Which tumour suppressor proteins does HPV inactivate?

A

HPV E7/E6 inactivate Rb and p53 respectively

28
Q

How does HPV interrupt the cell cycle?

A
  • E7 proteins from HPV bind to pRb
  • sequestration removes Rb from cell cycle regulation which facilitates cell from growth suppression
  • oncoproteins produced bind to HYPO-phosphorylated pRb to act as a gatekeeper
  • this results in the cell cycle transit becoming blocked
29
Q

What is p53?

A
  • nuclear protein found in normal cells at low levels
  • known as the guardian of the genome as it protects cell through cell cycle arrest and apoptosis
  • when there is cellular stress, levels of p53 rapidly increase
30
Q

What happens when p53 is inactivated?

A
  • cancer cells must inactivate p53 pathway to be able to divide rapidly and survive
  • SV40 virus contains protein large T which binds to p53, resulting in its inactivation
  • this leads to the inhibition of apoptosis and allows the proliferation of cancer cells, resulting in tumourigenesis

Biology of Cancer (19 decks)

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