Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Reproduction > Cervical Cancer > Flashcards

Cervical Cancer Flashcards

(74 cards)

Start Studying
1
Q

What is HPV?

A

Human papilloma virus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What does HPV cause infections of?

A

Skin & mucous membranes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How is HPV spread?

A

HPV strains spread through childhood from direct skin-to-skin contact may lead to common warts (e.g. veruccas)
Other strains are sexually transmitted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How are the sexually transmitted strains of HPV split up?

A

Low risk groups - cause benign anogenital warts

High risk/oncogenic group - account for maj of cervical cancers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the low risk strains of HPV?

A

HPV 6/11

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the high risk strains of HPV?

A

16/18

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How can we prevent HPV?

A

Active HPV vaccination in teenagers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How do you cure HPV infection?

A

You cannot

It is persistent after primary infection (in infected basal cells of the mucosal skin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the lifetime exposure of HPV?

A

Up to 75%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

When is the peak prevalence of HPV infection?

A

15-25y

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What % of cervical cancers are caused by HPV?

A

> 99%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What other cancers can HPV cause?

A

Penile, vulva/vaginal, mouth, oropharynx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the aetiology of HPV infection leading to cervical cancer?

A

Micro-abrasion of cervical lining –> HPV invades basal cells where they stay for many years
Virus begins to mix with cells DNA & replicates & invades other cells (can be picked up as pre-cancerous)
Cells become damaged & disorganised –> high risk lesion
High grade pre-cancerous lesion grows & occupies whole thickness of skin
All cells infected & completely disorganised –> invasive cancer that can break through the skin & spread to other parts of the body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Early HPV infection may be accompanied by _______

A

Mild changes in epithelium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is an abnormal growth of squamous cells known as?

A

Squamous intraepithelial lesion (SIL)

Can be high grade/low grade depending on how much of the epithelium is effected & how abnormal the cells look

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Abnormal cells in the cervix can be detected by _____ and are classified as _________ graded:

A

Biopsy/histology

Cervical intraepithelial neoplasia
Graded 1 to 2 based on how much of the cervix is affected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Persistent infection with __________ is req for the development of cervical cancer

A

ONCOGENIC HPV types

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How do the CIN lesions progress?

A

CIN 1 may regress or progress to CIN 2/3 or cervical cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What happens to most low grade SILs?

A

They clear within 6-12m (probably due to immunological intervention)

Small % progress to high grade SIL (which is assoc. with CIN 2/3 at biopsy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What % of CIN 2/3 progress to carcinoma?

A

40%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Which strain of HPV has the most oncogenic potential?

A

16

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What cohort are vaccinated against HPV?

A

Girls born after 1st September 1990

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is in the HPV vaccine?

A

Now quadrivalent
HPV 16, 18, 11, 6
So prevents genital warts too

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

When is the HPV vaccine given to girls?

A

12-13 years in school

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Girls who have not been vaccinated have the same level of protection as those who aren't. Why is this?
Such high uptake of vaccine
26
What is involved in the process of cervical screening?
Receive invitation via mail if registered with a GP practice Done by Scottish Cervical Call Recall System Smear taken, details entered on SCCRS Slides stained & screened Cytology puts result on SCCRS During screening - small brush is used to collect some cells from the surface of the cervix which can be sent for liquid cytology
27
What is the endocervix?
Luminal cavity within cervix forming a passage between the external and internal Os
28
What sort of epithelium covers the endocervix?
Glandular, columnar
29
What covers the ectocervix?
Non-keratinising squamous epithelium
30
What is the squamocolumnar junction?
Junction between the squamous and columnar epithelium
31
How does the position of the SCJ change over time?
Birth/premenarchal - close to external os (original SCJ) Reproductive age - variable distances from external os Post-menopausal - SCJ recedes into endocervix (not visible) During pregnancy/OCP use - cervix enlarges & may be able to see SCJ on surface of cervix
32
What happens to the columnar epithelium when it is exposed to the vagina?
Undergoes normal metaplasia into squamous epithelium due to acidity of vagina
33
Why is the vagina so acidic?
Lactobacilli produce lactic acid which contributes to low pH of vagina
34
What is the distance between the original SCJ and the new SCJ known as?
Transformation zone
35
How will a woman find out her smear results?
She will be contacted after 2 weeks to find out her results
36
What happens if a woman has an abnormal smear?
She will be invited for colposcopy
37
What woman are screened for cervical changes?
25-64y | 5 yearly
38
How are smears checked?
Liquid based cytology Test if high risk HPV If +ve triage with cytology
39
What is the HPV test?
Molecular test on cells from cervix Identifies high risk HPV viral DNA/RNA Any high risk type --> type specific genotyping (Use LBC samples and use hybridisation/PCR)
40
Currently who gets a cervical cytology sample looked at? What does it involve?
ALL - but from 2020 only HPV +ve Microscopic assessment of cells scraped from transformation zone looking for abnormal cells (dyskaryosis) to see if woman has CIN - stained with PAP
41
What is the problem with the transformation zone?
Contains immature cells & due to the unstable hormonal environment it is particularly vulnerable to infection
42
How do you classify dyskaryosis?
Increased size and nuclear:cytoplam ratio Variation in size, shape & outline Course irregular chromatin Nucleoli Multinucleation Cells with wrinkled nucleus & perinuclear halo
43
How is dyskaryosis graded?
Low (+ borderline) - persisting infection/CIN1 | High - likely to progress to cancer (CIN2/3)
44
What are koliocytes?
Squamous epithelial cells that have undergone structural changes as a result of HPV infection
45
If you get a negative result for high risk HPV what is the protocol?
Routine recall in 5 years
46
If you get positive for high risk HPV what is the protocol?
Cytology normal - repeat test in 1y Dyskaryosis - refer for colposcopy
47
What is colposcopy?
Procedure to look at upper vagina, cervix & lower uterus Uses magnification and light Will exclude obvious malignancy
48
What chemical is used to help see precancerous changes? How is it helpful?
Acetic acid +/- iodine Can find limits of lesion, & where to biopsy
49
What should you do if you see a precancerous lesion on colposcopy?
Biopsy to make diagnosis | Rx if CIN2/3 or can see & treat at first visit
50
Summarise how a HPV infection leads to dyskaryosis
HPV infects basal cells in transformation zone via microtears Uses host for replication As host cell matures, different viral genes expressed At top layer fully assembled viruses shed E6 protein product inhibits cell death E7 protein product inhibits cell cycle arrest Overexpression of viral E6 and E7 --> dysregulation of host cell cycle
51
What is CIN?
Cervical intraepithelial neoplasia Visible to naked eye = disorganised proliferation of abnormal cells in squamous epithelium (lack of maturation, variation in cellular size & shape, nuclear enlargement, irregularity, hyperchromia, cellular disarray)
52
How do you diagnose CIN?
Biopsy
53
What is CIN 1?
Undifferentiated cells only occupy lowest 1/3rd of epithelium (surface cells can mature) Low grade dysplasia - should regress
54
What is CIN 2?
Undifferentiated cells occupy 2/3rd thickness & only top layers show maturation to medium sized cells Mod dysplasia, may regress
55
What is CIN3?
Neoplastic/undifferentiated cells full thickness of epithelium No normal differentiated cells Severe dysplasia, unlikely to regress
56
How do you Rx CIN?
LLETZ Thermal coagulation Thermal ablation
57
What is LLETZ?
Large loop excision of transformation zone | Diathermy used to cut area of abnormal cells away
58
Why is follow up of CIN after Rx req?
To confirm Rx effective & no cancer present now | Reassurance
59
When do we follow up CIN?
After Rx LBC at 6m for cytology & high risk HPV Both neg - return to recall Either positive - colposcopy
60
Do people with CIN have an increased risk of cervical cancer?
Yes | As compared to general pop
61
What is the peak age of cervical cancer?
45-55y
62
What is cervical cancer assoc with?
``` HPV (16/18) Multiple partners Early age at first intercourse Older partner of age Cigarette smoking ``` Higher incidence in deprived areas (more smoking, less likely to come for screening)
63
What are the symptoms of cervical cancer?
``` Abnormal vaginal bleeding PCB IMB/PMB Discharge Pain (lower back, pelvis, during sex) ```
64
How do you diagnose cervical cancer?
Clinical Screen detected Biopsy
65
What does cervical cancer look like histologically?
Tumour cells invade from epithelium into underlying stroma
66
What are the types of cervical cancer?
80% are squamous cell carcinoma More rarely can get adenocarcinoma (endocervical)
67
What is the staging for cervical cancer?
Stage 1A - invasive cancer identified only microscopically IA1 - <3mm depth and 7mm or less diam (=microinvasive) IA2 5mm+ x 7mm IB - tumour confined to cervix Stage 2 - spread to upper vagina (upper 2/3rd) Stage 3 - lower vagina, pelvis Stage 4 - rectum, ladder Metastatic - pelvic nodes, liver, lung, bone
68
How can you stage cervical cancer?
EUA (Ex under anaesthesia) PET-CT MRI
69
How do you Rx stage 1a1 cervical cancer?
Type 3 excision of cervical TZ or hysterectomy
70
How do you Rx stage 1b-2a cervical cancer?
Radical hysterectomy/radio + chemo
71
How do you Rx stage 2b-5?
Chemo + radio
72
What is involved in a radical hysterectomy?
Exploration of pelvic + para-aortic space Removal of uterus, cervix, upper vagina, parametria, pelvic nodes Ovaries conserved!
73
What kind of radio can you do?
External beam x 20 fractions | Caesium 24h insertion
74
What chemo can you give for cervical cancer?
5 cycles of cisplatin

Reproduction (28 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions