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Reproduction and Sexual Health > Cervical cancer > Flashcards

Cervical cancer Flashcards

1
Q

what is the appearance of normal ectocervix

A

basal membrane with stromal cells

cells at top have large cytoplasm with small nucleus

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2
Q

what is the appearance of normal endocervix

A

lined by a single layer of glandular epithelium and row of nuclei

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3
Q

what area in the cervix is most likely to be affected by dysplastic change

A

transformation zone (squamocolumnar junction)

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4
Q

what are the neoplastic changes that occur in the cervix

A

CIN

cervical cancer - either squamous carcinoma or adenocarcinoma

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5
Q

what is CIN

A

cervical intraepithelial neoplasia

precursor lesion for cervical squamous carcinoma

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6
Q

list the risk factors for cervical neoplasia

A

HPV - particularly type 16 and 18
many sexual partners
sex from a young age - vulnerable SC junction
long term use of oral contraceptives
smoking
immunosuppression
lack of using barrier contraception methods

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7
Q

describe the histology findings of HPV in a smear

A

thickened papillomatous squamous epithelium with cytoplasmic vacuolation
presence of koilocytes - epithelial cells with darker, larger nuclei present

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8
Q

how long does it take for HPV infection to turn to high grade CIN

A

6 months - 3 years

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9
Q

how long does it take for high grade CIN to turn to invasive cancer

A

5-20 years

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10
Q

what is CIN

A

pre-invasive stage of cervical cancer

occurs at transformation zone, dysplasia of squamous cell

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11
Q

does CIN have any symptoms

A

no - this is why it requires detection through cervical smear

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12
Q

describe the histology of CIN

A

delay in maturation, more immature cells at top of epithelium
hyperchromasia
increased nucleocytoplasmic ratio
pleomorphism

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13
Q

what is CIN I

A

basal 1/3 occupied by abnormal epithelium

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14
Q

what is CIN II

A

abnormal cells extended to middle 1/3 of epithelium

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15
Q

what is CIN III

A

abnormal cells occupy full thickness of the epithelium, also called carcinoma in situ

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16
Q

when does CIN become cervical squamous carcinoma

A

when there is a breach /invasion of the stroma

17
Q

what cervical cancer is more common, squamous cell or adenocarcinoma

A

squamous cell, makes up 75% of cervical tumours

18
Q

what is the most common symptom of cervical cancer

A

abnormal uterine bleeding - either postmenopausal, post-coital or contact bleeding on examination

19
Q

list the symptoms of a more advanced cervical cancer

A

pelvic pain
ureteric obstruction
haematuria/UTI

20
Q

where might a cervical cancer locally invade

A

uterine body, vagina, bladder, uterus, rectum

21
Q

how might a cervical cancer spread via lymphatics

A

pelvic and para-aortic nodes

22
Q

how might a cervical cancer spread haematogenously

A

liver
bone
lung

23
Q

what cell type does a CGIN originate from

A

from endocervical epithelium only

24
Q

what is CGIN a precursor lesion for

A

cervical adenocarcinoma

25
Q

what is harder to diagnose on a smear test CIN or CGIN

A

CGIN as less likely the region that is swabbed

26
Q

what are the risk factors for cervical adenocarcinoma

A

later onset of sexual activity
smoking
HPV especially type 18

27
Q

if patient has an abnormal smear test what happens next

A

if HPV positive repeat in 6 months
if mild dyskaryosis repeat in 6 months as can regress
if mod-severe dyskaryosis refer for colposcopy
if appearance is invasive, refer for colposcopy within 2 weeks

28
Q

when do women receive smear tests

A

25-49 every 3 years

50-65 every 5 years

29
Q

what level of CIN requires an excisional biopsy following colposcopy

A

CIN II or above

30
Q

outline the management of low risk cervical cancer (stages IA-IA2)

A

cured through local excision, IA2 has a small risk of nodal involvement so pelvic lymphadenactomy may be offered

31
Q

outline the management of moderate risk cervical cancer (IB-IIA)

A

radical hysterectomy + pelvic lymphadenectomy, oophrectomy can be performed by rarely spreads to the ovaries
radical radiotherapy + cisplastin are alternatives to surgery

32
Q

outline the management of stages IIB-IV of cervical cancer

A

usually radical radiotherapy + cisplastin chemotherapy

33
Q

what is a simple hysterectomy

A

removal of uterus, cervix and fallopian tubes

34
Q

what is a radical hysterectomy

A

removal of uterus, cervix, fallopian tubes + top 2cm of the vagina and tissues around the cervix

35
Q

list some side effects of radiotherapy targeted at the cervix

A

cystitis, diarrhoea, fibrosis causing vaginal stenosis and sexual dysfunction

36
Q

what is brachytherapy

A

insertion of radiotherapy directly into the body specifically targeting the desired area, sparing the surrounding organs

Reproduction and Sexual Health (22 decks)

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