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Reproductive Health > Cervical cancer > Flashcards

Cervical cancer Flashcards

1
Q

What is the majority of cervical cancers

A

80% are squamous cell carcinoma
Next most common is adenocarcinoma
Rare - small cell cancer

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2
Q

What is cervical cancer strongly ass with

A

HPV

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3
Q

What cancers is HPV ass with?

A

Anal
Vulval
Vaginal
Penis
Mouth
Throat

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4
Q

What types of HPV are ass with 70% of cervical cancers

A

16+18

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4
Q

What types of HPV are ass with 70% of cervical cancers

A

16+18

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5
Q

How does HPV cause cervical cancer

A

HPV -> two proteins E6 +E7 that inhibit p53 +pRb which are tumour supressor genes

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6
Q

Risk faactors for cervical cancer

A

Increased risk of catching HPV
Later detection of precancerous and cancerous changes (non-engagement with screening)
Other risk facotrs
Non engagement with cervical screening

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7
Q

What increases the risk of catching HPV

A

Early sexual activity
Increased number of sexual partners
Sexual partners who’ve had more partners
Not using condoms

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8
Q

Other risk factors for cervical cancers

A

Smoking
HIV
COCP > 5 years
FH
Increased no. full term pregnancies
Exposure to diethylstillbestrol during foetal development - used to prevent miscarriages before 1971

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9
Q

What are patients with HIV offered

A

Yearly smear tests

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10
Q

What to ask about in a history concerened about cervical cancer

A

Attendance to smears
Number sexual partners
FH
Smoking

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11
Q

Presentation of cervical cancer

A

Abnormal vaginal bleeding (intermenstrual, postcoital or post-menopausal bleeding)
Vaginal discharge
Pelvic pain
Dyspareunia

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12
Q

What appearance are abnormal on speculum

A

Ulceration
Inflammation
Bleeding
Visibile tumour

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13
Q

What appearance are abnormal on speculum

A

Ulceration
Inflammation
Bleeding
Visibile tumour

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14
Q

What do if abnormal appearcance of cervic

A

urgent cancer referral for colposcopy

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15
Q

What is the grading system for cervical cancer

A

cervical intraepithelial neoplasia

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16
Q

How is CIN diagnosed and hwat does it measure

A

Colposcopy
Dysplasia - premalignant change

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17
Q

What is CIN I grade

A

mild dysplasia, affecting 1/3 the thickness of the epithelial layer, likely to return to normal without treatment

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18
Q

What is CIN II grade

A

moderate dysplasia, affecting 2/3 the thickness of the epithelial layer, likely to progress to cancer if untreated

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19
Q

What is CIN III grade

A

severe dysplasia, very likely to progress to cancer if untreated
Or cervical carcinoma in situ

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20
Q

What is dyskaryosis found in

A

Smear results
Its abnormal cytologic changes of squamous epithelial cells characterized by hyperchromatic nuclei and/or irregular nuclear chromatin

21
Q

WHen are cells from smear tests examined

A

If HPV positive
If HPV negative considered negative smaple and not examined

22
Q

When is cervical screening offered to women

A

Every 3 years aged 25-49
Every 5 years aged 50-64

23
Q

Exceptions to the cervical screening programme

A

HIV - annual
>65 may request if not had one since 50
Women w prev CIN may require additional tests
Immunocompromised women additional screening (dialysism cytotoxic drugs, organ transplant)
Pregnant women due routine smear wait 12 weeks post partum

24
Q

Cytology results levels

A
  • Inadequate
  • Normal
  • Borderline changes
  • Low-grade dyskaryosis
  • High-grade dyskaryosis (moderate)
  • High-grade dyskaryosis (severe)
  • Possible invasive squamous cell carcinoma
  • Possible glandular neoplasia
25
Q

What infections may be identified and reported on a smear

A

BV
Candidiasis
Trichomoniasis

26
Q

What orgnaisms are often discovered in women with a coil? management?

A

Actinomyces-like organisms
no treatment unless symptomatic
If symptomatic remove the IUD (pelvic pain or abnormal bleeding)

27
Q

PHE guideleines on management of smear results

A
  • Inadequate sample – repeat the smear after at least three months
  • HPV negative – continue routine screening
  • HPV positive with normal cytology – repeat the HPV test after 12 months
  • HPV positive with abnormal cytology – refer for colposcopy
28
Q

What is a colposcopy

A

Insert speculum and using colposcope to magnify cervix to view epithelial lining of cervix to be examined in detail. Acetic acid and iodine solution stains used to differentiate abnormal areas

29
Q

How do abnormal cells appear on acetic acid stain

A

white - acetowhite
In cells with increased nuclear to cytoplasmic ratio (more nuclear material)
eg cervical intraepithelial neoplasia
Cervical cancer cells

30
Q

What will show with abnormal cells and iodine solution

A

Iodine solution stains healthy cells brwon - abnormal areas wont stain

31
Q

What can be performed during colposcopy to get tissue sample

A

Punch biopsy or large loop excision of transformational zone

32
Q

What is a large loop excision of transformtion zone

A

loop of wire w electrical current - diathermy - to remove abnormal epithelial tissues on cervix
Cauterises to stop bleeding

33
Q

What occurs after LLETZ

A

Bleeding
Abnormal discharge
Severeal weeks
Intercourse and tampon avoideed after procedure to reduce infection risk
Depth of tissue removed - deeper may mean risk of preterm labour

34
Q

What is a cone biopsy treatment for

A

Cervical intraepithelial neoplasia and early stage cervical cancer
Surgeon removes cone shaped piece cervic with scalpol

35
Q

Risks of cone biopsy

A

Pain
Bleeding
Infection
Scar formation with stenosis of cervix
Increased risk miscarraige and premature labour

36
Q

Staging for cervical cancer

A

FIGO - 4 stages

37
Q

Stage 1 cervical cancer

A

Confined to cervix

38
Q

Stage 2 cervical cancer

A

Invades uterus or upper 2/3 vagina

39
Q

Stage 3 cervical cancer

A

Invades pelvic wall or lower 1/3 vagina

40
Q

Stage 4 cervical cancer

A

Invades bladder, rectum or beyond pelvis

41
Q

What stage cervical cancer are the LLETZ or cone biopsy used to treat

A

Cervical intraepithelial neoplasia and early stage IA

42
Q

What is the treatment for stage IB-2A

A

Radical hysterectomy and removal of local lymph nodes with chemo and radiotherapy

43
Q

Stages 2B-4A cervical cancer management

A

Chemotherapy and radiotherapy

44
Q

Stage 4B cervical cancer maangement

A

Combination of surgery, radiotherapy, chemotherapy and palliative care

45
Q

Survival rate of cervical cancer

A

5 year survival
98% stage IA
15% stage 4

46
Q

What is pelvic exenteration

A

Operation in advanced cervical cancer
Removing most or all of pelvic organs incl vagina, cervix, uterus, fallopian tubes, ovaries, bladder and rectum
Vast operation with significant implications on quality of life

47
Q

What is bevacizumab (avastin)

A

Monoclonal antibody used in combination with other chemotherapies in treatment metastatic or recurrent cervical

48
Q

What does bevacizumab do

A

Target VEGF-A - vascular endothelial growth factor A, decreases levels therefore reduces development of new blood vessels

49
Q

Treatment for metastatic or recurrant cervical cancer

A

Bevacuzumab (avastin) monoclonal antibody

50
Q

What does the HPV vaccine protect against and why is it given at 12

A

Before become sezually active to stop HPV trasnmission
Gardasil - protects against 6,11,16 and 18

51
Q

What do HPV strains 6 and 11 cause

A

genital warts

Reproductive Health (69 decks)

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