Pelvic Masses Flashcards
(43 cards)
What are the two main strains of HPV associated with cervical cancer?
HPV 16 and 18
What increases risk of CIN?
more sexual partners and sex from a young age
prolonged use of COCP
smoking
CIN is a precursor to?
squamous cell carcinoma of the cervix
What percentage of cervical cancers are SCC?
90%
What is the aim of cervical screening?
to catch CIN before it becomes cancer
In scotland who is cervical screening done in?
those with a cervix should be screened every 5 years from age 25-65 years
Who may voluntarily withdraw of cervical screening?
never had any intimate contact men or women, if wont benefit e.g. terminally ill, unable to give adequate sample e.g. FGM, women with physical or learning disability that may make giving a sample distressing
Describe what is done with a smear test?
first it is tested for HPV, if negative nothing further is done, if positive look at the cytology
If a smear is negative what happens?
recall in 5 years
If a smear is positive HPV but negative cytology what happens?
recall in 12 months, only colposcopy if 3 consecutive samples are HPV positive
If smear is positive, and cytology is positive for low grade what is done?
seen for colposcopy within 8 weeks
If smear is positive for HPV, and cytology is positive and high grade what is done?
seen for colposcopy within 4 weeks
What happens if
If smear is positive for HPV, and glandular abnormality is seen or there is suspicion of invasion?
seen within 2 weeks
Describe colposcopy?
this allows the cervix to be examined in more detail through the use of a speculum and microscope
the squamocolumnar junction must be visualised
abnormal epithelium contains more protein and less glycogen than normal epithelium meaning when acetic acid is applied they appear white in colour and easily identifiable
can then take punch biopsy for histopathology
Describe treatment for CIN?
CIN 1: conservative management for 2 years
CIN 2 and 3: treatment in the form of excision or ablation
Describe presentation of cervical cancer?
may be asymptomatic in early stages post coital bleeding inter-menstrual bleeding menorrhagia pelvic pain offensive vaginal discharve in advanced disease: backache, leg pain, haematuria, weight loss, anaemia, changes in bowel habit
Describe stages of cervical cancer?
1: just in cervix (although A2 and B risk of lymph nodes involvement)
2: spread to adjacent organs e.g. vagina or uterus
3: involvement of pelvic wall
4: distant metastases or involvement of the bladder or rectum
Treatment of cervical cancer recurrences?
most recurrences are only suitable for palliative care
Describe the HPV vaccine?
this is for age 12-13 now given to boys as well as girls, in two doses six months apart
currently using quadrivalent vaccine covering 16,18,6 and 11
offers about 70% protection
nanovalent vaccine exists but not used in Uk yet
Most uterine malignancies arise from _____
the endometrium- most commonly adenocarcinoma
What is considered to increase risk of endometrial malignancy? What does this then mean?
high levels of oestrogen are considered to increase risk
factors that may increase oestrogen include: PCOS, late menopause, nulliparity, obesity, unopposed oestrogen, HRT, tamoxifen, oestrogen secreting tumours
interestingly evidence of endometrial cancer is lower in women who have used the COCP
Presentation of endometrial carcinoma?
AUB is principle symptom
post menopausal bleeding!
less commonly vaginal discharge
pain is rare in early disease
Post menopausal bleeding is ____
malignancy until proven otherwise
Investigations for endometrial carcinoma?
TV US is usually first line and in post menopausal women can measure endometrial thickness, smooth regular endometrium < 4 mm makes malignancy unlikely
endometrial biopsy
D and C
hysteroscopy allows visualisation of the uterine cavity, enabling biopsy/ curettage to be done
