Gynaecological cancers- Cerival cancer Flashcards
cervical cancer (types)
80% are squamous cell carcinoma, 20% adenocarcinoma
plus rarer types- small cell cancer
Human Papillomavirus HPV 16, 18
HPV vaccine
children aged 12-13 are vaccinated against strains of HPV to reduce risk of cervical cancer
given before they are sexually active to prevent spread of HPV
Gardasil vaccine protects against 6, 11, 16 and 18
6, 11= genital warts
16, 18= cervical cancer
cervical screening/smear test
Every three years aged 25 – 49
Every five years aged 50 – 64
smear test to screen for precancerous and cancerous changes to the cell of the cervix.
practice nurse
speculum examination and collection of cells from the cervix using a small brush and deposited into a preservation fluid
transported ‘liquid-based cytology’
tested for high-risk HPV before examined
if HPV -ve cells are not examined
if the smear is -ve, return to the screening programme.
Inadequate Normal Borderline changes Low-grade dyskaryosis High-grade dyskaryosis (moderate) High-grade dyskaryosis (severe) Possible invasive squamous cell carcinoma Possible glandular neoplasia
looked under lab microscope for precancerous changes (dyskaryosis)
early detection can promt treatment
HPV
most common cause of cervical cancer is infection with the HPV, strain 16, 18
HPV is associated with anal, vulvar, penis, mouth and throat cancers.
how does HPV cause cancer?
HPV produces two proteins, E6 and E7 which inhibit the tumour suppressor genes p53 (E6) and pRb (E7) promoting the development of cancer
risk factor for cervical cancer
increasing risk of catching HPV: early sexual activity, increased number of sexual partners, not using condoms
non-engagement with cervical screening
smoking, HIV, COCP for more than 5 years, full-term pregnancies, family history, exposure to diethylstilbestrol *was used to prevent miscarriages before 1971
cervical cancer clinical features
asymptomatic
abnormal bleeding- intermenstrual, post-coital, postmenopausal
vaginal discharge
pelvic pain
dyspareunia (pain or discomfort with sex)
urgent cancer referral for colposcopy
abnormal appearance of the cervix on speculum
ulceration
inflammation
bleeding
visible tumour
colposcopy: use a colposcope to magnify the cervix to see the epithelial lining in more detail.
stain with acetic acid and iodine solution.
What is CIN?
Cervical intraepithelial neoplasia
a grading system for the level of dysplasia (premalignant changing) in the cells of the cervix.
diagnosed with colposcopy not screening:
CIN I: mild dysplasia, affecting 1/3 the thickness of the epithelial layer, likely to return to normal without treatment
CIN II: moderate dysplasia, affecting 2/3 the thickness of the epithelial layer, likely to progress to cancer if untreated
CIN III: severe dysplasia, very likely to progress to cancer if untreated
CIN III is sometimes called cervical carcinoma in situ.
exceptions to cervical smears
Women with HIV are screened annually
Women over 65 may request a smear if they have not had one since aged 50
Women with previous CIN may require additional tests (e.g. test of cure after treatment)
Certain groups of immunocompromised women may have additional screening (e.g. women on dialysis, cytotoxic drugs or undergoing an organ transplant)
Pregnant women due a routine smear should wait until 12 weeks post-partum
summary of smear results
Inadequate sample – repeat the smear after at least three months
HPV negative – continue routine screening
HPV positive with normal cytology – repeat the HPV test after 12 months
HPV positive with abnormal cytology – refer for colposcopy
staining used in colposcopy
acetic acid: causes abnormal cells to appear WHITE
‘act white’
occurs in cells with an increased nuclear to cytoplasmic ratio (cervical intraepithelial neoplasia/cervical cancer)
schiller’s iodine test: stain cells of the cervix with iodine solution. healthy= brown, abnormal= does not stain
punch biopsy or large loop excision of the transformational zone to get a tissue sample.
Large Loop Excision of the Transformation Zone (LLETZ)
‘loop biopsy/
local anaesthetic during colposcopy
loop wire with electrical current (diathermy) to remove abnormal epithelial tissue on the cervix
*diathermy cauterises to stop bleeding
bleeding can occur after this procedure (intercourse and tampon avoided = infection)
cone biopsy
treatment for CIN and early-stage cervical cancer
general anaesthetic
the surgeon removes a cone-shaped piece of the cervix with a scalpel. histology for malignancy.
risks: Pain
Bleeding
Infection
Scar formation with stenosis of the cervix
Increased risk of miscarriage and premature labour
FIGO stage cervical cancer:
Stage 1: Confined to the cervix
Stage 2: Invades the uterus or upper 2/3 of the vagina
Stage 3: Invades the pelvic wall or lower 1/3 of the vagina
Stage 4: Invades the bladder, rectum or beyond the pelvis
