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Reproductive and sexual medicine > Cervical cancer > Flashcards

Cervical cancer Flashcards

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1
Q

Who is most commonly affected by cervical cancer

A

Younger women in reproductive years

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2
Q

What are the most common forms of cervical cancer

A

Squamous cell carcinoma (80%) - Epithelium
Adenocarcinoma - Glandular
Small cell (rare)

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3
Q

What is the most common cause of cerical cancer?

A

HPV infection

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4
Q

What cancers are associated with HPV infection?

A

Anal
Vulval
Vagina
Penis
Mouth
Throat

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5
Q

How is HPV spread

A

Sexually

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6
Q

What are the 2 main strains of HPV that cause cervical cancer?

A

16 and 18

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7
Q

How can HPV cause cervical cancer

A

HPV produces E6 ad E7 proteins, which inhibit the P53 (6) and pRb (7) tumour suppressor genes

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8
Q

How can risk factors for cervical cancers be divided?

A

Increased risk of catching HPV
Later detection of precancerous changes
Others

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9
Q

What are some factors that increase risk of catching HPV

A
  • Early sexual activity
  • Increased number of sexual partners
  • Sexual partners who have had more partners
  • Not using condoms
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10
Q

What is the main cause of later detection of pre-cancerous changes in cervical cancer

A

Non-engagement with cervical screening

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11
Q

What are some other risk factors for cervical cancer?

A
  • Smoking
  • HIV(patients with HIV are offered yearly smear tests)
  • Combined contraceptive pilluse for more than five years
  • Increased number offull-term pregnancies
  • Family history
  • Exposure todiethylstilbestrolduring fetal development (this was previously used to prevent miscarriages before 1971)
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12
Q

How are most cases of cervical cancer found?

A

During cervical smears (Usually as a precancerous lesion)

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13
Q

What are some symptoms that suggest cervical cancer

A
  • Abnormal vaginal bleeding (intermenstrual,postcoitalorpost-menopausal bleeding)
  • Vaginal discharge
  • Pelvic pain
  • Dyspareunia (pain or discomfort with sex)
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14
Q

What should be done if symptoms suspicious of cervical cancer are found

A

Cervical examination with speculum
Swabs to exclude infection

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15
Q

What should be done is the cervix appears abnormal on speculum exam

A

Urgent cancer referral for colposcopy

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16
Q

What are some cervical features suspicious of cervical cancer

A
  • Ulceration
  • Inflammation
  • Bleeding
  • Visible tumour
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17
Q

What are the 2 forms of premalignant lesions for cervical cancer

A

Cervical intraepithelial neoplasia (CIN)
Cervical glandular intraepithelial neoplasia (CGIN)

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18
Q

What is CIN?

A

A pre-invasive stage of cervical cancer, in which there is dysplasia of the squamous cells at the transformation zone

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19
Q

What is CGIN?

A

A pre-invasive stage of cervical adenocarcinoma, affecting the glandular cells at the transformational zone

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20
Q

How many stages of CIN are there

A

3

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21
Q

CIN stage 1

A

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

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22
Q

CIN stage 2

A

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

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23
Q

CIN stage 3

A

severe dysplasia, very likely to progress to cancer if untreated
(Cervical carcinoma in situ)

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24
Q

What is the name for pre-cancerous changes on smear test?

25
What is involved in smear testing
A small brush is used to collect cells from the transition zone of the cervix
26
What tests are performed in a smear test
1st - High-risk HPV If positive 2nd - Cytology
27
What is the Scottish cervical screening process
Smear test every 5 years from ages 25-64
28
What are some exceptions to the cervical screening programme
- HIV (Anual screening) - >65 (Still screened if no screening since 50) - Women with previous CIN (Require additional tests) - Immunocompromised women - Post-partum women (Screening should wait until 12 weeks)
29
What are some cytology results
- Inadequate - Normal - Borderline changes - Low-grade dyskaryosis - High-grade dyskaryosis (moderate) - High-grade dyskaryosis (severe) - Possible invasive squamous cell carcinoma - Possible glandular neoplasia
30
What is done is smear test shows inadequate sample
Repeat after 3 months
31
What is done if hrHPV is negative
Continue routine screening
32
What is done if hrHPV is positive but cytology is normal
Repeat HPV test after 12 months
33
What is done if hrHPV is positive with abnormal cytology
Colposcopy
34
What is involved in colposcopy
Speculum examination with colposcope to magnify the cervix
35
What are some stains used in colposcopy
Acetic acid Iodine
36
What is acetic acid used for in colposcopy
Shows abnormal cells as white (Acetowhite) CIN and cervical cancer cells turn white due to increased nucleus:cytoplasmic ratio
37
What is Schiller's iodine test used for in colposcopy
Stains normal cells brown, with abnormal tissue not staining
38
What are some tissue sampling methods that can be used during colposcopy?
Large Loop Excision of the Transformational Zone (LLETZ) Cone biopsy
39
What is involved in LLETZ
Local anaesthetic given Electrically charged wire used to remove abnormal tissue and cauterise the tissue
40
What are some side-effects or risks of LLETZ
Bleeding Abnormal discharge Pre-term labour
41
What should be avoided after LLETZ
Intercourse Tampon (Risk of infection)
42
What is the treatment of CIN and very-early stage?
Cone biopsy or LLETZ
43
What is involved in cone biopsy
General anaesthetic Surgeon removed a cone-shaped piece of the cervix using a scalpel This is also sent for histopathology
44
What are some risks of cone biopsy
- Pain - Bleeding - Infection - Scar formation with stenosis of the cervix - Increased risk of miscarriage and premature labour
45
What is FIGO stage 1 cervical cancer
Confined to cervix
46
What is FIGO stage 2 cervical cancer
Invades the uterus or upper 2/3rds vagina
47
What is FIGO stage 3 cervical cancer
Invades the pelvic wall or lower 1/3 of vagina
48
What is FIGO stage 4 cervical cancer
Invades the bladder, rectum or beyond the pelvis
49
Management of stage 1B-2A cervical cancer
Radical hysterectomy and removal of local lymph nodes with chemotherapy and radiotherapy
50
Management of stage 2B-4A cervical cancer
Chemotherapy and radiotherapy
51
Management of stage 4B cervical cancer
Management may involve a combination of surgery, radiotherapy, chemotherapy and palliative care
52
What is the 5 year survival rate for cervical cancer?
1A = 98% 4 = 15%
53
What is pelvic exenteration?
an operation that may be used in advanced cervical cancer. It involves removing most or all of the pelvic organs, including the vagina, cervix, uterus, fallopian tubes, ovaries, bladder and rectum. It is a vast operation and has significant implications on quality of life.
54
What is Bevacizumab (Avastin)
a monoclonal antibody that may be used in combination with other chemotherapies in the treatment of metastatic or recurrent cervical cancer. It is also used in several other types of cancer. It targets vascular endothelial growth factor A (VEGF-A), which is responsible for the development of new blood vessels. Therefore, it reduces the development of new blood vessels.
55
When is the HPV vaccine given?
Given ages 9-26, but most effective ages 11-12 Should be given before they become sexually active
56
What is the current NHS HPV vaccine
Gardasil Covers strains 6, 11, 16 and 18
57
What are the 3 surgical management options for cervical cancer?
Trachelectomy Simple hysterectomy Radical hysterectomy
58
What is trachelectomy
Removal or the cervix with a margin This is then sutured closed (Fertility maintained with C-section birth)
59
What are the most common chemotherapy drugs used in cervical cancer
Cisplatin Carboplatin + Paclitaxel

Reproductive and sexual medicine (78 decks)

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