PBL 1 Flashcards
describe the structure of the cervix in terms of walls?
the internal os is between the uterus and cervix and the external os is between the cervix and vagina, with the endocervical canal in between
whats the histology of the exocervix?
stratified squamous epithelium
what’s the histology of the endocervix?
simple columnar epithelium
what is the squamocolumnar junction?
the precise histological transition between squamous and columnar epithelium
location is variable
when does the squamocolumnar junction move?
during early adolescence and the first pregnancy
where is the transformation zone of the cervix?
between the original and new squamocolumnar junctions
whats important about the transformation zone of the cervix?
its hormonally responsive and is a zone of metaplasia so is the usual site of cervical carcinoma
What types of cancer can strains of HPV cause?
cervical anus penis vagina vulva oropharynx
how is HPV transmitted?
sexually or through skin to skin contact e.g. pregnancy
what are 5 types of warts caused by HPV?
genital warts common warts plantar warts flat warts filiform warts
what are the key features of genital warts?
small califlower-like bumps on genitals
may be itchy or tender
what are the key features of common warts?
rough, raised bumps on hands or fingers
can be painful and bleed
what are the key features of plantar warts?
hard, grainy growths on heels or balls of feet that may cause discomfort
what are the key features of flat warts?
flat-topped slightly raised lesions mainly on face (kids), beard area (men) and legs (women)
what are the key features of filiform warts?
long projections of the skin often around eyes or lips (also called digitate or facial warts)
what is respiratory papillomatosis?
a wart-like growth or tumor on the surface of the larynx caused by HPV
what are the symptoms of respiratory papillomatosis?
voice changes high pitched breath sounds coughing choking snoring dysphagia
what are the 2 types of HPV infection?
cutaneous (skin) or mucosal
outline the pathophysiology of HPV?
cuts can allow the virus to reach the basal cell layer of stratified squamous epithelial cells. The infection of basal cells stimulates cellular proliferation in the basal layer through their 2 viral genes; E6 and E7. This leads to uncontrolled cell growth of epithelial cells forming warts and lesions and an icnreased viral load as it copies itself. Infected cells move up through the skin layers, reaching the top and releasing new viruses.
what do E6 and E7 do?
E6 oncoprotein inhibits p53’s tumour suppressor function whilst E7 binds to the retinoblastoma tumour suppressor gene (pRb) product inhibiting it so that cell growth cant be inhibited.
what are koilocytes?
cells with irregular shapes, enlarged and dark staining nucleus and a paranuclear halo
what does dyskaryosis mean?
the change of appearance in cells that cover the surface of the cervix
what does the transformation of pre-cancerous lesions to cervical carcinomas depend on?
HPV type
length of infections
cofactors e.g. tobacco use, immunosuppression
why is smoking a risk factor for cervical cancer?
tobacco by-products have been found in the cervical mucus of women who smoke. It’s thought that these substances damage the DNA of cervical cells
which HPV types are responsible for most harmless warts?
6 and 11
which HPV strains are responsible for most cancers?
16 and 18
what are some risk fcators for HPV?
high number of sexual partners being an adolescent weakened immune system damaged skin personal contact
how can you prevent HPV?
being in a mutually monogamous sexual relationship
reducing number of sexual partners
using latex condoms
having HPV vaccines before the age sexual contact starts
regular check ups and Pap tests
what are the ways in which we diagnose HPV?
Acetic acid solution test
Pap test
DNA test
how can we treat warts caused by HPV?
they often go away without treatment but we can give solutions such as salicylic acid, imiquimod, trichloroacetic acid and podofilox.
we can also use cryotherapy, electrocautery, surgical removal and laser removal
what does imiquimod do?
helps to boost the immune system so the person can remove the infection alone
why are Pap tests so efficient at preventing cervical cancer?
because it takes such a long time for an HPV infection to become an invasive cancerous growth.
why are Pap test so important for the diagnosis of cervical cancer?
Because it doesnt cause any noticeable symptoms in early stages
what is a colposcopy?
using a colposcope to provide a magnified view of the cervix
how can precancerous cervical cancer lesions be removed?
cryosurgery laser surgical removal loop electrosurgical excision procedures cold knife conization
what is cervical intraepithelial neoplasia?
a precancerous condition in which abnormal cells grow on the surface of the cervix
what is grade 1 cervical cancer?
when only the lower 1/3rd of the epithelium is affected
what is grade 2 cervical cancer?
when 2/3rds of the epithelium are affected
what is grade 3 cervical cancer?
when almost all the epithelium is affected
what is the carcinoma in situ stage of cervical cancer?
when the entire thickness of the epithelium is affected
what is invasive cervical cancer?
When cancerous cells break through the epithelial basememnt membrane and into the cervical stroma. Then it can spread to neighbouring tissues/through the pelvic wall
what are symptoms of cervical cancer?
abnormal vaginal bleeding especially after sexual intercourse vaginal discomfort unpleasant smelling vaginal discharge pain when urinating lower back/pelvis/stomach pain constipation and bloody urine
what are some risk factors for cervical cancer?
being under 45
having a weakened immune system
giving birth to multiple children or having children under age of 17
if you have had cancer in the past
if your mother took diethylstilbestrol whilst pregnant with you
outline when you will be invited to cervucal screening?
every 3 years from ages of 25-49
every 5 years from ages of 50-64
only over 65s if one of the last 3 tests was abnormal
when will you not be invited for cervical screening?
before the age of 25
after the age of 65
if you have had a total hysterectomy
what type of vaccine is the HPV vaccine?
a non-infectious recombinant vaccine
when is the HPV vaccine offered?
to girls/boys at the age of 12-13
which HPV vaccine do we currently used?
Gardasil 9
what does Gardasil 9 protect against?
HPV 6,11,16,18,31,33,45,52,58
should you get the HPV vaccine if you have already got HPV?
yes because although it cannot get rid of HPV infections, it can prevent infections with other strains of HPV or re-infection of the same strain
what does the Gardasil 4 vaccine protect against?
HPV 6,11,16,18
what does the cervarix vaccine protect against?
HPV 16 and 18
which diseases do HPV vaccines protect against?
cervical cancer, head and neck cancers and some cancers of the anal and genital areas.
what is metaplasia?
When a mature differentiated cell type is replaced by another, but better suited, mature differentiated cell type because of an environmental stressor.
what is dysplasia?
the abnormal development of cells within tissues or organs
what is neoplasia?
new, uncontrolled growth of cells that is not under physiologic control.
outline the stages of change leading to cancer?
A normal cell experiences DNA damage due to an environmental/inherited mutation. These mutations lead to the activation of oncogenes and inactivation of tumour suppressor genes. This leads to uncontrolled proliferation of abnormal, mutating cells = malignant neoplasm
why is angiogenesis important in cancer growth?
solid tumours need a blood supply if they grow over a few mm
how does cancer growth stimulate angiogenesis?
cancer cells secrete angiogenic factors
what is an invasive neoplasm?
Cancer that has spread beyond the layer of tissue in which it developed and is growing into surrounding, healthy tissues.
what does SPIKES stand for? (breaking bad news)
setting up perception invitation knowledge emotion strategy
what does ABCDE stand for? (breaking bad news)
Advanced preparation Build therapeutic environmenet communicate well deal with patient/family reactions Encourage and validate emotions
