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Year 5 Cancer > Y5 - Cervical cancer & intraepithelial neoplasia > Flashcards

Y5 - Cervical cancer & intraepithelial neoplasia Flashcards

1
Q

def of cervical cancer

A

a human papillomavirus-related malignancy of the uterine cervical mucosa

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2
Q

what is the most important aetiological factor for cc

A

human papillomavirus

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3
Q

what are the two most common HPVs in cc

A

HPV-16 and HPV-18

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4
Q

when is peak infection incidence for HPV

A

teens and early 20s

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5
Q

how much more common is hpv infection than pre-invasive disease (cervical intra-epithelial neoplasia)

A

1000-fold more common

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6
Q

what oncoproteins drive cervical intra-epithelial neoplasia

A

E6 (binds p53) and E7 (interacts with retinoblastoma protein)

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7
Q

what does e6 binding to p53 do

A

blocks apoptosis

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8
Q

what does e7 binding to pRb do

A

causes release of E2F from pRb cells which drives cells into the cycle

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9
Q

epi of cc

A

4th most common malignancy in women

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10
Q

RFs

A

smoking
COCP
immunosuppression

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11
Q

signs and symptoms

A

RFs (45-49yrs, HPV infection, multiple sexual partners)
vaginal bleeding
pelvic pain

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12
Q

what is used to screen for cc

A

Pap smear and HPV testing

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13
Q

which is better pap smearing or HPV testing

A

HPV testing is more sensitive

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14
Q

investigations

A

vaginal or speculum examination
colposcopy
biopsy
HPV testing

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15
Q

what would you look for on vaginal or speculum examination

A

mass or cervical bleeding

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16
Q

what would you look for on colposcopy

A

abnormal vascularity

white change with acetic acid

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17
Q

when is HPV testing indicated

A

with an atypical Pap smear

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18
Q

screening for cc

A

pap test every 3 years for women 21-65yrs

pap and HPV testing every 5 years for women 30-65yrs

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19
Q

management for IA1: microinvasive disease

A 
local excision (conisation)
adjunct with hysterectomy or chemoradiation
20
Q

what is chemoradiation for cc

A

cisplatin and radiation

21
Q

management for IA2-IB1: early stage disease

A 
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
22
Q

management for IB2-IIA: early stage disease

A
  • hysterectomy and lymphadenectomy

- chemoradiation

23
Q

management for IIB-IVA: locally advanced disease

A

chemoradiation

24
Q

management for metastatic disease

A

combination chemotherapy (bevacizumab, cisplatin, paclitaxel)

25
Q

management for cc in pregnant lady

A

MDT and delivery at 35wks

26
Q

complications

A

bleeding

sexual dysfunction

27
Q

prognosis

A

may spread in the lymphatics to the pelvic or paraaortic lymph nodes
or in the blood to the lungs or bone

28
Q

what is the 5yr survival dependent on

A

Staging

29
Q

what is the 5 yr prognosis of a stage IA1 tumour

A

100%

30
Q

what is the 5 yr prognosis of a stage IB2-IIB tumour

A

60%

31
Q

what is the 5 yr prognosis of a stage III tumour

A

40%

32
Q

what is the 5 yr prognosis of a stage IV tumour

A

10%

33
Q

what is cervical intraepithelial neoplasia also known as

A

cervical dysplasia

34
Q

what is CIN

A

the premalignant transformation of cells of the cervix

35
Q

where does CIN most commonly occur

A

the squamo-columnar junction (the transitional area between the squamous epithelium of the vagina and the columnar epithelium of the endocervix)

36
Q

what is necessary for CIN

A

HPV infection

37
Q

do all cases of CIN progress to cc

A

no, majority are removed by the immune system, however some become cc (most commonly cervical squamous cell carcinoma)

38
Q

signs and symptoms of CIN

A

bleeding
discharge
pelvic pain

39
Q

what is the cause of CIN

A

chronic infection with HPV

40
Q

what is the earliest microscopic change in CIN

A

dysplasia of the epithelial lining of the cervix

41
Q

what is the purpose of the PAP smear

A

to test for precancerous changes

42
Q

management of CIN

A

removal or destruction of abnormal cervical cells

43
Q

what grading system is used for CIN

A

Bethesda system

44
Q

what is CIN 1 grade

A

mild dysplasia or abnormal cell growth

confined to basal 1/3 of epithelium

45
Q

what is CIN 2 grade

A

mix of low and high grade lesions

confined to basal 2/3 of epithelium

46
Q

what is CIN 3 grade

A

severe dysplasia with undifferentiated neoplastic cells which span more than 2/3 of the epithelium

47
Q

how commonly does CIN progress to cc

A

in 10% of CIN1 and 20 of CIN2

Year 5 Cancer (25 decks)

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