Flashcards in Cervical cancer Deck (31):
Who is screened in the cervical screening programme? How often?
*25 -49 years =screened every 3 years
*50-64years =screened every 5 years
How does pregnancy effect cervical screening?
*Usually delayed until 3months post-partum unless missed screening or previous abnormal smears
How is cervical screening performed?
*swab of the cervix
*tested for HPV
*If positive for HPV then looking at the cells
What increases the risk of cervical cancer?
HPV 16, 18 and 33
What is the management of borderline or mild dyskariosis detected on cervical screening
*Colposcopy to determine whether CN1, CN2, or CN3
What is the management of moderate/severe dyskariosis or suspected invasive cancer detected on cervical screening?
*Refer for urgent colposcopy within 2 weeks
What is the meaning of a CIN1 result after colposcopy? How is it managed?
*Atypical cells found only in the lower 1/3 of the epithelium
*Unlikely the cells will become cancerous and may go away on their own
*no treatment needed
*invited for cervical screening test in 12 months to check they have gone
What is the meaning of a CIN2 result after colposcopy? How is it managed?
*Atypical cells found in the lower 2/3 of the epithelium
*Moderate chance the cells will become cancerous
*Treatment to remove them is usually recommended
What is the meaning of a CIN3 result after colposcopy? How is it managed?
*Atypical cells occupy the full thickness of the epithelium
*Also considered carcinoma in situ/no invasion
*malignancy ensues if these abnormal cells invade through the basement membrane
*High chance cells will become cancerous
*Treatment to remove is recommended
What treatment is given to results of CIN2 or CIN3 to remove abnormal cervical cells?
*Large loop excision of transformation zone (LLETZ)
=the specimen is then examined histologically to rule out malignancy
Who is the HPV vaccine given to? Why?
*All 12 - 13 year olds in year 8
*Helps to protect against: cervical cancer, mouth/throat cancer, anal and genital cancers
Who is included in the breast cancer screening programme?
*Women aged 47-73
*Every 3 years offered a mammogram
What is the epidemiology of cervical cancer?
*50% of cases occur in women under 45
*incidence rates highest in people aged 25-29
How can cervical cancer be divided histologically? What is more common?
*Squamous cell cancer (90%)
*Adenocarcinoma (10%) =originating from the columnar epithelium
What does CIN stand for? What does it mean?
*Cervical intraepithelial neoplasia
=this is the presence of atypical cells within the squamous epithelium
=The atypical cells are dyskaryotic exhibiting larger nuclei with frequent mitoses
What is the pathology of HPV in the consideration of the development of cervical cancer?
*As the columnar epithelium undergoes metaplasia to squamous epithelium in the transformtion zone, exposure to HPV results in incorporation of viral DNA into the cell DNA
*Viral proteins inactivate key cell tumour suppressor gene products and push the cell into a cell cycle
*Over time other mutations accumulate and lead to carcinoma
*failure of immune system to detect and destroy these cells
How does cervical cancer present?
*Occult carcinoma: detected during routine cervical smear
*Abnormal vaginal bleeding: postmenopausal, intermenstrual, post-coital
*Abnormal vaginal discharge (offensive)
*Pain as a late feature
Late stage involvement of the ureters, bladder, rectum and nerves:
*Rectal bleeding and pain
What risk factors increase the chance of cervical cancer?
*HPV 16, 18 and 33
*Early first intercourse
*Multiple sexual partners
*Lower socioeconomic status
Is suspected CIN1, CIN2 or CIN3 in colposcopy, what can be taken before treating?
*Small biopsy of abnormal area
*Confirmatory results awaited before performing LLETZ
Where does cervical cancer rank of the gynae cancers for how common it is?
3rd after uterine and ovarian
What can sometimes be seen on examination for cases of cervical cancer?
*Early disease =cervix appears normal to the naked eye
*Ulcer or mass may be visible or palpable
What spead and staging system is used for cervical carcinoma?
The international federation of gynae and obstetrics classification (FIGO)
What does each stage in the FIGO classification mean?
*Lesions confined to the cervix
*invasion is into the vagina, but not the pelvic side wall
*Invasion of lower vagina or pelvic wall, or causing ureteric obstruction
*Invasion of bladder or rectal mucosa, or beyond the true pelvis
What does the FIGO classification for cervical cancer not consider? What does this make it?
Limited predictor of survival because it does not include whether there is lymph node involvement
What is the treatment of microinvasive disease, stage 1a cervical cancer? Complications
=As risk of lymph node spread only 0.5%
>preterm labour in subsequent pregnancies
*Simple hysterectomy preferred in older women
What is the treatment of stage 1b/c and stage 2a?
Choice is between surgery and chemo-radiotherapy
*If LN involved, latter is preferred
>pelvic node clearance, hysterectomy and removal of the parametrium and upper third of the vagina (ovaries left in young women with sqaumous carcinoma)
*Radical trachelectomy in women who wish to conserve fertility
What is the treatment of stage 2b and above or lymph nodes positive?
What radiotherapy treatment can be used in cervical cancer?
Combination of external beam therapy and intracavity brachytherapy is used
What are the complications of radiotherapy?
*Acute: change in bowel frequency, including diarrhoea
*Subacute bowel obstruction
*Dysuria and frequency
What chemotherapy treatment is most commonly given?
Topotecan in combination with cisplatin