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Cancer Flashcards

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1
Q

What is the most common type of cervical cancer?

A

Squamous cell carcinoma

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2
Q

What percentage of cervical cancers are squamous cell carcinomas?

A

80%

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3
Q

What is 2nd most common type of cervical cancer?

A

Adenocarcinoma

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4
Q

How do we screen for cervical cancer?

A

Smear tests

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5
Q

What is the most common cause of cervical cancer?

A

HPV

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6
Q

How do people become infected with HPV?

A

HPV is an STI

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7
Q

Which strains of HPV are responsible for 70% of cervical cancer?

A

16 and 18

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8
Q

Can you treat a HPV infection?

A

No - most resolve in 2 years spontaneously

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9
Q

How do we prevent HPV infections?

A

All children 12-13 are given the vaccine

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10
Q

How does HPV cause cancer?

A

Creates 2 proteins that inhibit P53 and pRb

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11
Q

What are the names of the proteins that inhibit P53 and pRb?

A

E6 (P53) and E7 (pRb)

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12
Q

What are the risk factors for Cervical cancer?

A

Increased risk of catching HPV
Later detection of precancerous and cancerous changes
Smoking
HIV
COCP
Increased number of full term pregnancies
FHx

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13
Q

How do people with cervical cancer present?

A

Asymptomatic but

  • Abnormal vaginal bleeding
  • Vaginal discharge
  • Pelvic pain
  • Dyspareunia
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14
Q

If abnormal cervix seen on speculum, what is the next investigation?

A

Colposcopy

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15
Q

What does CIN stand for?

A

Cervical Intraepithelial Neoplasia

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16
Q

What is CIN I?

A

Mild dysplasia

1/3 of thickness of epithelial layer

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17
Q

What are the results of CIN I?

A

Likely to return normal without treatment

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18
Q

What is CIN II?

A

Moderate dysplasia

Affect 2/3 of thickness of epithelial layer

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19
Q

What are the results with a CIN II?

A

Likely to become cancer if untreated

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20
Q

What is CIN III?

A

Severe dysplasia

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21
Q

What is the result in someone with CIN III?

A

Very likely to progress to cancer if untreated

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22
Q

What is CIN III also known as?

A

Cervical carcinoma in situ

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23
Q

What is CIN?

A

Grading system for the level of dysplasia in cells of the cervix

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24
Q

What is the screening test for Cervical cancer?

A

Smear test

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25
What does a smear test consist of?
Speculum exam and collection of cells
26
What is tested for on a smear sample?
Dyskaryosis (Pre-cancerous changes) | High-risk HPV
27
How often do you do a smear test for someone 25-49?
Every 3 years
28
How often do you do a smear test for someone 50-64?
Every 5 years
29
How often do you do a smear on someone with HIV?
Annually
30
Can women >65 request a smear?
Yes, if they havent had one since 50
31
Do you do a smear on pregnant people?
If their routine smear comes up while pregnant, wait until 12-weeks post-partum
32
What are the cytology results on a smear test?
``` Inadequate Normal Borderline changes Low / High-grade dykaryosis Possible invasive SCC Possible glandular neoplasia ```
33
Which STIs can be identified on smear test?
Bacterial Vaginosis Candidiasis Trichomoniasis
34
What can be seen in women with an IUD?
Actinomyces-like organisms
35
How do you manage an inadequate sample smear test?
Repeat after 3 months
36
How do you manage a HPV negative smear test?
Continue routine screening
37
How do you manage a smear test that is HPV positive with normal cytology?
Repeat the HPV test after 12 months
38
How do you manage a smear test that is HPV positive with abnormal cytology?
Refer for colposcopy
39
What is colposcopy?
A specialist procedure where you insert a speculum and use a colposcope to magnify the cervix
40
Which stains are used in colposcopy?
Acetic acid | Iodine solution
41
Why do we use acetic acid on colposcopy?
Makes abnormal cells appear white
42
What is Schiller's iodine test?
Stains healthy cells brown. Abnormal areas will not stain
43
What procedure is done to get a tissue sample?
Punch Biopsy or Large loop excision of the transformational zone
44
What is a large loop excision of the transformation zone?
AKA Loop Biopsy | Loop of wire with electric current (diathermy) to remove abnormal epithelial tissue on the cervix
45
What is normal after an LLETZ?
Bleeding and abnormal discharge | Avoid tampons and intercourse after the procedure to reduce infections
46
What is a cone biopsy?
Treatment for CIN
47
What are the risks of cone biopsy?
``` Pain Bleeding Infection Scar formation with stenosis of cervix Increased risk of miscarriage and premature labour ```
48
What is the staging system for cervical cancer?
FIGO
49
What are the stages in FIGO?
Stage 1: Confined to Cervix Stage 2: Invades Uterus or upper 2/3 of vagina Stage 3: Invades pelvic wall or lower 1/3 of vagina Stage 4: Invades the bladder, rectum or beyond pelvis
50
How do you manage CIN?
LLETZ / Cone biopsy
51
How do you manage stage 1B - 2A cervical cancer?
Radical hysterectomy | Removal of local lymph nodes with chemo and radiotherapy
52
How do you manage stage 2B - 4A cervical cancer?
Chemotherapy and Radiotherapy
53
How do you manage stage 4B cervical cancer?
Surgery Radiotherapy Chemotherapy Palliative care
54
What is the 5-year survival in the different stages of cervical cancer?
Stage 1A - 98% | Stage 4 -15%
55
What is Pelvic exenteration and why is it done?
Operation to remove all or most pelvic organs | Can be used for advanced cervical cancer
56
Can you use any drugs to treat it? And how does it work?
Bevacizumab (Avastin) is a VEGF-A antibody, preventing new blood vessels from forming
57
Which HPV strains are int he vaccines and what do they cause?
HPV 6 and 11 - Warts | HPV 16 and 18 - Cervical cancer
58
When is the HPV vaccine given and to who?
All children before they become sexually active (12-13)
59
What is Endometrial cancer?
Cancer of the endometrium, the lining of the uterus
60
What are the types of endometrial cancer?
80% are adenocarcinomas
61
Are endometrial cancers oestrogen dependent?
Yes
62
What is Endometrial hyperplasia?
Precancerous condition involving thickening of the endometrium.
63
What are the risk factors for endometrial cancer?
``` Increased age Earlier onset of menstruation Late menopause Oestrogen only HRT No/Fewer pregnancies Obesity PCOS Tamoxifen ```
64
Why does PCOS cause increased risk of endometrial cancer?
PCOS causes it by having unopposed oestrogen | Anovulation in PCOS means no progesterone to protect the endometrial lining
65
Why is obesity a risk factor for endometrial cancer?
Adipose tissue is a source of oestrogen
66
What are protective factors for endometrial cancer?
COCP Mirena Coil Increased pregnancies Cigarette smoking
67
How do those with endometrial cancer present?
``` Post menopausal bleeding - most common Postcoital bleeding Intermenstrual bleeding Abnormal vaginal discharge Haematuria Anaemia Raised platelet count ```
68
What investigations are done for endometrial cancer?
Transvaginal ultrasound (measures endometrial thickness) Pipelle biopsy Hysteroscopy
69
What is a pipelle biopsy?
Speculum exam while inserting a thin tube through the cervix into the uterus

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