Cervical Cancer Flashcards
(36 cards)
What is ectropion?
Why does it occur?
- during puberty, rising levels of oestrogen cause the cervix to evert
- the columnar tissue lining the cervical canal is everted onto the surface of the cervix
- the area of columnar tissue in the centre of the cervix is known as ectopy / ectropion
What is the transformation zone?
How is it related to ectropion?
- the columnar cells on the surface of the cervix undergo squamous metaplasia
- this is a normal process caused by acidic conditions in the vagina
- the point where the columnar cells transform into squamous cells is the transformation zone
How might cervical intraepithelial neoplasia (CIN) develop?
- CIN can develop if oncogenic HPV affects the transformation zone
- CIN forms instead of normal squamous tissue
Where are samples taken from in cervical screening?
When can this be difficult?
- samples are taken from the transformation zone of the cervix
- this is more difficult in postmenopausal women
- the transformation zone is not visible with a speculum as it retracts
What is the most common cause of cervical cancer?
human papilloma virus (HPV)
- this is a sexually transmitted infection
- types 16 and 18 are responsible for 70% cervical cancers
- most cases of HPV resolve spontaneously within 2 years
it is also associated with anal, vulval, vaginal, penis, mouth + throat cancers
What is the vaccination schedule against HPV?
- 12- and 13- year old girls are offered a bivalent vaccine against HPV 16 + 18
- this prevents 90% genital warts and 60-70% CIN
What are the risk factors for cervical cancer associated with increased risk of catching HPV?
- unprotected sex
- sexually active from a young age
- multiple sexual partners
- sexual partners who have had more partners
What is the biggest risk factor for cervical cancer?
non-engagement with cervical screening
- many cases of cancer are preventable with early detection + treatment of precancerous changes
What are the other risk factors associated with cervical cancer?
- smoking
- HIV (immunosuppression)
- COCP use for > 5 years
- increased number of full term pregnancies
- family history
- exposure to diethylstilbestrol during fetal development (used prior to 1971)
people with HIV are offered yearly smear tests due to increased risk
What are the presenting symptoms that may be associated with cervical cancer?
- abnormal vaginal discharge (persistent, offensive, blood-stained)
- abnormal bleeding (PCB, PMB or IMB)
- dyspareunia
- pelvic pain (late disease)
many of these symptoms are non-specific and NOT caused by cancer
PCB = post-coital bleeding
IMB = intermenstrual bleeding
PMB = post-menopausal bleeding
If someone presents with cancer-associated symptoms, what should be done?
speculum examination
- this allows visualisation of the cervix
- swabs can be taken to exclude infection
this should be followed by bimanual and PR examination
What signs on speculum examination are red flags?
- ulceration
- inflammation
- bleeding
- visible tumour
- if any of these are seen, an urgent 2WW referral for colposcopy should be made
What is involved in a cervical smear test?
- a speculum is inserted and a small brush is used to collect cells from the transformation zone of the cervix
- this aims to pick up precancerous changes (CIN) in the cervical epithelial cells
- the cells are deposited in preservation fluid
- they are examined under a microscope for dyskaryosis
Before the cells from the smear test are examined microscopically, what is done?
- the cells are initially tested for high-risk HPV
- if this is negative, the cells are not examined
- the woman is returned to the routine screening programme
Who is offered cervical screening?
- every 3 years aged 25-49
- every 5 years aged 50-65
- women > 65 can request a smear test
How is dyskaryosis assessed?
- nuclear enlargement
- variation in size / shape of the nuclei
- hyperchromasia
- reduction in cytoplasm, altering the nuclear:cytoplasmic ratio
hyperchromasia - the nuclei appear dark / smudged / opaque when stained
What else may be detected / reported on the smear result?
- trichomonas
- candidiasis
- bacterial vaginosis
- actinomyces-like organisms in women with an intrauterine device
What are the 4 different potential outcomes of a smear test?
inadequate sample:
- repeat smear after at least 3 months
HPV negative:
- continue routine screening
HPV positive with normal cytology:
- repeat HPV test in 12 months
HPV positive with abnormal cytology:
- refer for colposcopy
What is cervical intraepithelial neoplasia?
- a grading system for the level of dysplasia (premalignant change) in the cells of the cervix
- this is diagnosed at colposcopy, and not on screening
- dysplasia is found during colposcopy
- dyskaryosis is found on cervical smear test
What is meant by CIN I?
mild dysplasia
- this affects 1/3 thickness of the epithelial layer
- likely to return to normal without treatment
- when confined to the epithelial layer, this is a pre-invasive change
- it becomes cancer when it invades below the epithelial layer
What is meant by CIN II?
moderate dysplasia
- this affects 2/3 thickenss of the epithelial layer
- likely to progress to cancer if not treated
What is meant by CIN III?
severe dysplasia
- this affects the whole epithelial layer
- very likely to progress to cancer
- sometimes called cervical carcinoma in situ
What is involved in colposcopy?
- a speculum is inserted and a colposcope is used to magnify the cervix
- the whole transformation zone is examined
- stains - aceitic acid and iodine solution - are used to differentiate abnormal areas
Why is acetic acid used and what is a positive result?
- abnormal cells will stain white (acetowhite)
- this occurs in cells with increased nuclear-to-cytoplasmic ratio
- e.g. CIN / cervical cancer
