Cervical cancer Flashcards by Hannah Nolan

What is the majority of cervical cancers

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

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What is cervical cancer strongly ass with

HPV

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What cancers is HPV ass with?

Anal
Vulval
Vaginal
Penis
Mouth
Throat

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

16+18

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

16+18

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How does HPV cause cervical cancer

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

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Risk faactors for cervical cancer

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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What increases the risk of catching HPV

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

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Other risk factors for cervical cancers

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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What are patients with HIV offered

Yearly smear tests

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What to ask about in a history concerened about cervical cancer

Attendance to smears
Number sexual partners
FH
Smoking

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Presentation of cervical cancer

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

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What appearance are abnormal on speculum

Ulceration
Inflammation
Bleeding
Visibile tumour

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What appearance are abnormal on speculum

Ulceration
Inflammation
Bleeding
Visibile tumour

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What do if abnormal appearcance of cervic

urgent cancer referral for colposcopy

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What is the grading system for cervical cancer

cervical intraepithelial neoplasia

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How is CIN diagnosed and hwat does it measure

Colposcopy
Dysplasia - premalignant change

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What is CIN I grade

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

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What is CIN II grade

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

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What is CIN III grade

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

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What is dyskaryosis found in

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

WHen are cells from smear tests examined

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

When is cervical screening offered to women

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

Exceptions to the cervical screening programme

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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

Cytology results levels

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

What infections may be identified and reported on a smear

BV Candidiasis Trichomoniasis

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

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

PHE guideleines on management of smear results

* 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

What is a colposcopy

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

How do abnormal cells appear on acetic acid stain

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

What will show with abnormal cells and iodine solution

Iodine solution stains healthy cells brwon - abnormal areas wont stain

What can be performed during colposcopy to get tissue sample

Punch biopsy or large loop excision of transformational zone

What is a large loop excision of transformtion zone

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

What occurs after LLETZ

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

What is a cone biopsy treatment for

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

Risks of cone biopsy

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

Staging for cervical cancer

FIGO - 4 stages

Stage 1 cervical cancer

Confined to cervix

Stage 2 cervical cancer

Invades uterus or upper 2/3 vagina

Stage 3 cervical cancer

Invades pelvic wall or lower 1/3 vagina

Stage 4 cervical cancer

Invades bladder, rectum or beyond pelvis

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

Cervical intraepithelial neoplasia and early stage IA

What is the treatment for stage IB-2A

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

Stages 2B-4A cervical cancer management

Chemotherapy and radiotherapy

Stage 4B cervical cancer maangement

Combination of surgery, radiotherapy, chemotherapy and palliative care

Survival rate of cervical cancer

5 year survival 98% stage IA 15% stage 4

What is pelvic exenteration

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

What is bevacizumab (avastin)

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

What does bevacizumab do

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

Treatment for metastatic or recurrant cervical cancer

Bevacuzumab (avastin) monoclonal antibody

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

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

What do HPV strains 6 and 11 cause

genital warts

Cervical cancer Flashcards

(52 cards)