Cervical Cancer Flashcards
(42 cards)
Approximately how many women are diagnosed with cervical cancer per year in the UK? Approximately how many die from the disease?
Approximately 2000 women are diagnosed with cervical cancer per year in the UK. Less than 1000 die from the disease.
Squamous cell carcinoma accounts for ___ of cervical cancer cases and adenocarcinoma accounts for ___.
Squamous cell carcinoma accounts for more than 75% of cervical cancer cases and adenocarcinoma accounts for 25% of cases.
What is the main risk cancer for cervical cancer?
HPV.
What are the risk factors for HPV?
1) . High numbers of sexual partners
2) . High risk male partner
3) . Smoking
4) . Long-term use of oral contraceptives
5) . Early age of onset if first intercourse
6) . Early pregnancy
7) . Immunocompromised (HIV)
8) . Other STD’s eg. Chlamydia and Herpes
Why is early age of intercourse/pregnancy a risk factor for cervical cancer?
Early age of first intercourse/pregnancy is relevant because of the position of the transformation zone. Eversion of the endocervical epithelium enables easier access to the basal layer of the epithelium.
What is the most important risk factor for acquiring HPV?
Sexual behaviour. In women who have first intercourse aged 14-15 years the risk of cervical cancer is two-fold compared to women aged 20+.
The number of sexual partners is a factor and whether they have had multiple sexual partners.
There have been many studies that have shown that sexual behaviour is the most important risk factor for acquiring HPV.
Why is smoking a risk factor for acquiring HPV?
Research suggests that smoking leads to an increased risk of cervical cancer.
Benzoapyrene (BaP) which is a cigarette carcinogen has been found in cervical mucus.
BaP could enhance viral persistence in the cells so that there is an increased risk of cervical cancer.
What other virus apart from HPV is implicated with an increased risk of cervical cancer?
Herpes Simplex 2 is a virus that has been implicated in cervical cancer. The virus participates as a cofactor along with HPV.
Herpes Simplex 2 only has a modest effect on the risk of cervical cancer compared to HPV which has a strong effect.
What type of cervical cancer has Chlamydia Trachomatis been implicated with?
Chlamydia Trachomatis has been indicated as a cofactor associated with squamous cell carcinoma if the cervix but not with other cervical cancers.
Why is HIV a risk factor for cervical cancer?
HIV is a risk factor in cervical cancer because an immunosuppressed woman would not be able to fight off any HPV infection. Women who have advanced immunosuppression are more vulnerable to high risk types of HPV.
How many different types of HPV are there?
More than 100.
Which types of HPV are high risk and therefore associated with high grade cervical intraepithelial neoplasia (CIN), invasive squamous cell carcinoma of the cervix, and cervical adenocarcinoma?
HPV types 16, 18, 31, 33 and 45.
How does HPV usually infect the cervix?
HPV usually infects the basal layer due to a very slight abrasion in the cervix. Most HPV infections are cleared by the immune system but long term persistence of the virus is a factor in the development of the disease.
What genes does HPV cause the expression of?
HPV causes the expression of E6 and E7 genes.
What do the E6 and E7 genes which are expressed as a result of HPV infection do?
E6 binds to and inhibits p53 (the protein product of a tumour suppressor gene) causing uncontrolled progression through the cell cycle.
E7 binds Rb. Rb is a tumour suppressor protein that is usually free to bind the E2F transcription factor thus preventing excess E2F from causing uncontrolled cell cycle progression. When E7 binds Rb, E2F remains unbound and results in uncontrolled cell cycle progression.
HPV has a ________ and __________ phase in its life cycle.
HPV has a latent and productive phase in its life cycle.
What are the 5 possible results of a cervical smear?
1) . Borderline nuclear changes
2) . Mild dyskaryosis
3) . Moderate dyskaryosis
4) . Severe dyskaryosis
5) . Glandular neoplasia
How would you deal with a patient that showed borderline nuclear changes?
Repeat the smear in 6 months.
Not more than 3 borderline smears 6 months apart or 3 abnormal smears in 10 years.
HPV triage.
How would you deal with a patient that had moderate dyskaryosis, severe dyskaryosis or glandular neoplasia?
Refer them for colposcopy.
Describe a cervical punch biopsy.
A woman will first be microscopically examined by colposcopy.
If any abnormal area is found then a punch biopsy is taken using punch biopsy forceps.
This is a superficial biopsy (3mm max).
Describe the process of a LLETZ.
Depending on the results of a cervical punch biopsy the next step may be to take a LLETZ. This can be performed in a colposcopy outpatients clinic under local anaesthesia.
A low voltage electric current is delivered via a thin wire that is passed through the tissue. It is used to cut away abnormal tissue. A thin layer of normal looking tissue may also be removed to ensure complete excision. The healing process may also get rid of residual abnormal tissue if it is scanty. The abnormal tissue is examined in histo.
Colposcopy prior to LLETZ involves the application of acetic acid to visualise a reticular delicate vascular pattern.
The depth of the specimen is very important. You want 8mm depth with clear margins.
Describe a cold knife core biopsy.
Cold knife core biopsies are now decreasing in frequency. They require a fully equipped theatre.
This method is mostly used for micro invasive carcinoma where CIN3 is present at the margins or there is some glandular neoplasia.
Biopsy may be a depth of 1.2-2cm. This goes deep enough to compromise the internal OS of the cervix. Therefore there is a risk to future pregnancies and a bleeding issue.
What does a hysterectomy involve and when may it be carried out?
A hysterectomy may be carried out when a woman has repeated abnormalities and has already completed her family.
It involves the removal of the uterine corpus, uterine cervix and possibly the upper part of the vagina. If the woman is premenopausal they leave the ovaries, otherwise a complete abdominal hysterectomy will be carried out.
If there is invasive cancer of a certain measurement then a procedure called a radical hysterectomy may be carried out which includes the removal of the upper third of the vagina and the ligaments including vessels and lymph nodes.
If there is invasive cervical cancer exceeding a certain measurement what procedure may be carried out?
If there is invasive cancer of a certain measurement then a procedure called a radical hysterectomy may be carried out which includes the removal of the upper third of the vagina and the ligaments including vessels and lymph nodes.
