Y5 - Cervical cancer & intraepithelial neoplasia Flashcards
def of cervical cancer
a human papillomavirus-related malignancy of the uterine cervical mucosa
what is the most important aetiological factor for cc
human papillomavirus
what are the two most common HPVs in cc
HPV-16 and HPV-18
when is peak infection incidence for HPV
teens and early 20s
how much more common is hpv infection than pre-invasive disease (cervical intra-epithelial neoplasia)
1000-fold more common
what oncoproteins drive cervical intra-epithelial neoplasia
E6 (binds p53) and E7 (interacts with retinoblastoma protein)
what does e6 binding to p53 do
blocks apoptosis
what does e7 binding to pRb do
causes release of E2F from pRb cells which drives cells into the cycle
epi of cc
4th most common malignancy in women
RFs
smoking
COCP
immunosuppression
signs and symptoms
RFs (45-49yrs, HPV infection, multiple sexual partners)
vaginal bleeding
pelvic pain
what is used to screen for cc
Pap smear and HPV testing
which is better pap smearing or HPV testing
HPV testing is more sensitive
investigations
vaginal or speculum examination
colposcopy
biopsy
HPV testing
what would you look for on vaginal or speculum examination
mass or cervical bleeding
what would you look for on colposcopy
abnormal vascularity
white change with acetic acid
when is HPV testing indicated
with an atypical Pap smear
screening for cc
pap test every 3 years for women 21-65yrs
pap and HPV testing every 5 years for women 30-65yrs
management for IA1: microinvasive disease
local excision (conisation) adjunct with hysterectomy or chemoradiation
what is chemoradiation for cc
cisplatin and radiation
management for IA2-IB1: early stage disease
if >2cm and fit for surgery -hysterectomy and lymph node removal -chemoradiation if >2cm and not fit for surgery -chemoradiation if <2cm -trachelectomy (removal of cervix) and lymph node removal
management for IB2-IIA: early stage disease
- hysterectomy and lymphadenectomy
- chemoradiation
management for IIB-IVA: locally advanced disease
chemoradiation
management for metastatic disease
combination chemotherapy (bevacizumab, cisplatin, paclitaxel)
management for cc in pregnant lady
MDT and delivery at 35wks
complications
bleeding
sexual dysfunction
prognosis
may spread in the lymphatics to the pelvic or paraaortic lymph nodes
or in the blood to the lungs or bone
what is the 5yr survival dependent on
Staging
what is the 5 yr prognosis of a stage IA1 tumour
100%
what is the 5 yr prognosis of a stage IB2-IIB tumour
60%
what is the 5 yr prognosis of a stage III tumour
40%
what is the 5 yr prognosis of a stage IV tumour
10%
what is cervical intraepithelial neoplasia also known as
cervical dysplasia
what is CIN
the premalignant transformation of cells of the cervix
where does CIN most commonly occur
the squamo-columnar junction (the transitional area between the squamous epithelium of the vagina and the columnar epithelium of the endocervix)
what is necessary for CIN
HPV infection
do all cases of CIN progress to cc
no, majority are removed by the immune system, however some become cc (most commonly cervical squamous cell carcinoma)
signs and symptoms of CIN
bleeding
discharge
pelvic pain
what is the cause of CIN
chronic infection with HPV
what is the earliest microscopic change in CIN
dysplasia of the epithelial lining of the cervix
what is the purpose of the PAP smear
to test for precancerous changes
management of CIN
removal or destruction of abnormal cervical cells
what grading system is used for CIN
Bethesda system
what is CIN 1 grade
mild dysplasia or abnormal cell growth
confined to basal 1/3 of epithelium
what is CIN 2 grade
mix of low and high grade lesions
confined to basal 2/3 of epithelium
what is CIN 3 grade
severe dysplasia with undifferentiated neoplastic cells which span more than 2/3 of the epithelium
how commonly does CIN progress to cc
in 10% of CIN1 and 20 of CIN2
