VIA Screening Flashcards
Where are 85-95% of cervical cancers located?
Squamocolumnar junction
Briefly describe the pathophysiology of cervical cancer.
epithelial cell > Immune response/ DNA repair> Infection> Persistent infection> Pre-cancerous lesions> Genome instability> Invasive cancer
Mention the 4 major steps in cervical cancer development.
- Oncogenic HPV infection of the epithelial cells at the cervical transformation zone.
- Persistence of the HPV infection,
- Progression of a clone of epithelial cells from persistent viral infection to pre-cancer cells.
- Development of carcinoma and invasion through the basement membrane.w
Which 2 types of HPV are the main causes of cervical cancer?
HPV-16 and HPV-18
Give 2 HPV-related risk factors for cervical ca.
-Early onset of sexual activity
-Multiple sexual partners
-Having a high risk sexual partner
Give 6 other risk factors for cervical ca.
-Hx of STI
-Immunosuppression
-Early age of 1st birth (<20 yrs)
-Parity >3
-Hx of vulvar/vaginal cancer
-Low socioeconomic status
-Oral contraceptive use
-Cigarette smoking
What are the signs and symptoms of cervical ca? (4)
Usually asymptomatic in early stages
-Unusual/abnormal vaginal bleeding
-Abnormal vaginal discharge
-Vaginal discomfort
O/E: roughened/hard cervix, loss of fornices/fixed cervix
Give 2 late signs and symptoms of cervical ca.
-Loss of appetite, weight loss and fatigue
-Persistent pain in the pelvis, back and legs
-Leg swelling
-Bloody/painful urine
Name the 4 investigations used to diagnose cervical ca.
1) HPV-DNA Testing
2) Visual Inspection with Acetic Acid
3) Papanicolaou Smear (PAP Smear)= cytology
4) Colposcopy
List the steps for VIA screening.
- Ensure privacy
- Lithotomy position
- Inspect specula at 45 degrees angle
- Visualise cervix and clean
- Apply 3-5% acetic acid with cotton swab
- Wait for 1-3 min
- Inspect the cervix for white lesions
When do you do cryotherapy? (3)
-Entire squamocolumnar junction junction is visible
-Entire lesion is visible and does not extend into the endocervix
-Lesion covers less than 75% of ectocervix
What do we do for a patient who is not eligible for cryotherapy?
-Loop Electrosurgical Excision Procedure (LEEP)
-Send sample for histology
What is done for patients with visible lesion in cervix/vagina? (3)
Direct biopsy and send sample for histology
Perform a vaginal and rectal examination
Order the following investigations:
Bloods: FBC, U&C&E, LFTs, PITC for HIV.
Imaging: Abdominal & pelvic US, CXR (MRI scan)
How do you move forward with an abnormal PAP Smear? (2)
Colposcopy with directed biopsies
If no lesion seen: perform endocervical curettage
FIGO Staging.
See handout
