Cervical cancer Flashcards
Causes of Cervical cancer
The primary cause of cervical cancer is persistent infection with certain strains of the human papillomavirus (HPV).
Weakened immune system
Smoking
Long-term use of hormonal contraceptives
Multiple sexual partners
Early sexual activity
History of sexually transmitted infections (STIs)
Family history of cervical cancer
Symptoms of Cervical cancer
Non-invasive cancer has late symptoms.
Invasive cancer:
Abnormal vaginal bleeding, such as bleeding between periods, after intercourse, or after menopause
Unusual vaginal discharge that may be watery, bloody, or have a foul odor
Pelvic pain or pain during intercourse
Painful urination
Diagnosis of Cervical cancer
1)Pap test (Pap smear):
○ Collection of cells from the cervix to detect dysplasia and cervical cancer
○ Women with Pap smears with atypical glandular cells need endometrial
spampling
○ Cytology via the CIN, bethesda scale.- normal, atypical, CIN 1 or LSIL, HSIL
or CIN 2 and 3, invasive carcinoma
○ Atypical:
■ Positive HPV: needs colposcopy and biopsy of abnormal findings.
■ Negative HPV: repeat Pap in 1 year
○ CIN 1 managed by close observation and repeat cytology for most. Rarely
ablative measures used in older age.
■ Ablation/destruction of tissue such as cryotherapy
■ Excision: removal of tissue such as loop electrode excision procedure
○ CIN 2
■ Women age <30 years managed with observation
■ Women age >30 years managed ideally with excisional method
○ CIN 3 managed with excisional method
○ After ablative or excisional method, Pap tests every 6 months for 2 years
2) HPV DNA test: This test detects the presence of high-risk HPV strains.
3) Colposcopy: A colposcope is used to examine the cervix for abnormalities.
4) Biopsy: If abnormal cells are found, a small tissue sample (biopsy) may be taken for further examination.
Treatment of Cervical cancer
○ Stage 0 (Carcinoma in situ): At this early stage, the cancer is confined to the surface layer of the cervix. Treatment options may include:
Loop electrosurgical excision procedure (LEEP) or cone biopsy, Cryotherapy, Laser therapy, Hysterectomy
○ Stage I: Cancer has spread beyond the surface layer of the cervix but is still localized within the cervix. Treatment options may include:
Surgery: Radical hysterectomy (removal of the uterus, cervix, and surrounding tissues) along with removal of pelvic lymph nodes.
Radiation therapy: External beam radiation therapy (EBRT) or brachytherapy (internal radiation) may be used alone or in combination with surgery.
Chemoradiation: Combining chemotherapy with radiation therapy may be recommended.
○ Stage II: Cancer has spread beyond the cervix but is still confined to the pelvic area. Treatment options may include:
Combined chemoradiation: Chemotherapy is given along with radiation therapy to enhance the treatment effectiveness.
Radiation therapy: EBRT and brachytherapy may be used, sometimes followed by surgery.
Radical hysterectomy: In some cases, surgery may be performed if the tumor is small and manageable.
○ Stage III: Cancer has spread to the lower third of the vagina or to the pelvic wall. Treatment options may include:
Combined chemoradiation: Chemotherapy is given along with radiation therapy.
Radiation therapy: EBRT and brachytherapy may be used, sometimes followed by surgery.
Chemotherapy: In some cases, chemotherapy may be used as the primary treatment.
○ Stage IV: Cancer has spread beyond the pelvic area or has invaded nearby organs or distant sites. Treatment options may include:
Chemoradiation: Chemotherapy is given along with radiation therapy.
Palliative therapy: Treatment focuses on relieving symptoms and improving quality of life, rather than aiming for a cure. This may involve pain management, radiation therapy, chemotherapy, or other supportive measures.
○Surgery:
■ This can involve removing the abnormal tissue or the entire cervix (trachelectomy or hysterectomy).
■ All should be treated with hysterectomy and lymphadenectomy, except stage IA which may be treated with conization.
○ Conization
■ cone-shaped piece of abnormal tissue is removed from the cervix. A scalpel, a laser knife, or a thin wire loop heated by an electric current may be used to remove the tissue. The tissue is then checked under a microscope for signs of disease. Conization may be used to check for cervical cancer or to treat certain cervical conditions.
■Types of conization are LEEP (loop electrosurgical excision procedure) and
cold knife conization (cold knife cone biopsy).
○Radiation therapy/Chemotherapy:
■After stage IIB, chemo (cisplatin, bleomycin) and radio should begin
○Targeted therapy:
■Bevacizumab . By blocking VEGF, bevacizumab inhibits the growth of blood vessels in the tumor, thereby limiting its blood supply.
■Pembrolizumab: Pembrolizumab is an immune checkpoint inhibitor that targets the programmed death receptor-1 (PD-1) protein. It enhances the immune response against cancer cells by blocking the PD-1 pathway, which can suppress the immune system’s ability to recognize and attack cancer cells. Pembrolizumab is used for the treatment of advanced or metastatic cervical cancer that has progressed despite other treatments.
■Cisplatin: It works by damaging the DNA of rapidly dividing cancer cells, thereby inhibiting their growth. Cisplatin can be used as both a targeted therapy and a standard chemotherapy agent.
■Topotecan: Topotecan is a topoisomerase inhibitor that disrupts DNA replication and cell division. It is used as a chemotherapy drug for the treatment of recurrent or metastatic cervical cancer that has progressed after initial treatment.
○ HPV vaccination: 3 doses over 6 months for Boys and girls ages 9-26 years.
Against HPV 6,11,16,18, 31,33,52
Complications of Cervical cancer
Spread of cancer to nearby tissues or organs (metastasis)
Recurrence of cancer after treatment
Infertility or difficulty becoming pregnant after certain treatments
Emotional and psychological effects of the diagnosis and treatment
