Y5 - Cervical cancer & intraepithelial neoplasia Flashcards Preview

Year 5 Cancer > Y5 - Cervical cancer & intraepithelial neoplasia > Flashcards

Flashcards in Y5 - Cervical cancer & intraepithelial neoplasia Deck (47):
1

def of cervical cancer

a human papillomavirus-related malignancy of the uterine cervical mucosa

2

what is the most important aetiological factor for cc

human papillomavirus

3

what are the two most common HPVs in cc

HPV-16 and HPV-18

4

when is peak infection incidence for HPV

teens and early 20s

5

how much more common is hpv infection than pre-invasive disease (cervical intra-epithelial neoplasia)

1000-fold more common

6

what oncoproteins drive cervical intra-epithelial neoplasia

E6 (binds p53) and E7 (interacts with retinoblastoma protein)

7

what does e6 binding to p53 do

blocks apoptosis

8

what does e7 binding to pRb do

causes release of E2F from pRb cells which drives cells into the cycle

9

epi of cc

4th most common malignancy in women

10

RFs

smoking
COCP
immunosuppression

11

signs and symptoms

RFs (45-49yrs, HPV infection, multiple sexual partners)
vaginal bleeding
pelvic pain

12

what is used to screen for cc

Pap smear and HPV testing

13

which is better pap smearing or HPV testing

HPV testing is more sensitive

14

investigations

vaginal or speculum examination
colposcopy
biopsy
HPV testing

15

what would you look for on vaginal or speculum examination

mass or cervical bleeding

16

what would you look for on colposcopy

abnormal vascularity
white change with acetic acid

17

when is HPV testing indicated

with an atypical Pap smear

18

screening for cc

pap test every 3 years for women 21-65yrs
pap and HPV testing every 5 years for women 30-65yrs

19

management for IA1: microinvasive disease

local excision (conisation)
adjunct with hysterectomy or chemoradiation

20

what is chemoradiation for cc

cisplatin and radiation

21

management for IA2-IB1: early stage disease

if >2cm and fit for surgery
-hysterectomy and lymph node removal
-chemoradiation
if >2cm and not fit for surgery
-chemoradiation
if <2cm
-trachelectomy (removal of cervix) and lymph node removal

22

management for IB2-IIA: early stage disease

-hysterectomy and lymphadenectomy
-chemoradiation

23

management for IIB-IVA: locally advanced disease

chemoradiation

24

management for metastatic disease

combination chemotherapy (bevacizumab, cisplatin, paclitaxel)

25

management for cc in pregnant lady

MDT and delivery at 35wks

26

complications

bleeding
sexual dysfunction

27

prognosis

may spread in the lymphatics to the pelvic or paraaortic lymph nodes
or in the blood to the lungs or bone

28

what is the 5yr survival dependent on

Staging

29

what is the 5 yr prognosis of a stage IA1 tumour

100%

30

what is the 5 yr prognosis of a stage IB2-IIB tumour

60%

31

what is the 5 yr prognosis of a stage III tumour

40%

32

what is the 5 yr prognosis of a stage IV tumour

10%

33

what is cervical intraepithelial neoplasia also known as

cervical dysplasia

34

what is CIN

the premalignant transformation of cells of the cervix

35

where does CIN most commonly occur

the squamo-columnar junction (the transitional area between the squamous epithelium of the vagina and the columnar epithelium of the endocervix)

36

what is necessary for CIN

HPV infection

37

do all cases of CIN progress to cc

no, majority are removed by the immune system, however some become cc (most commonly cervical squamous cell carcinoma)

38

signs and symptoms of CIN

bleeding
discharge
pelvic pain

39

what is the cause of CIN

chronic infection with HPV

40

what is the earliest microscopic change in CIN

dysplasia of the epithelial lining of the cervix

41

what is the purpose of the PAP smear

to test for precancerous changes

42

management of CIN

removal or destruction of abnormal cervical cells

43

what grading system is used for CIN

Bethesda system

44

what is CIN 1 grade

mild dysplasia or abnormal cell growth
confined to basal 1/3 of epithelium

45

what is CIN 2 grade

mix of low and high grade lesions
confined to basal 2/3 of epithelium

46

what is CIN 3 grade

severe dysplasia with undifferentiated neoplastic cells which span more than 2/3 of the epithelium

47

how commonly does CIN progress to cc

in 10% of CIN1 and 20 of CIN2