Cervical Cancer

Question 1

What is the aetiology of cervical cancer?

Answer 1

• HPV causes 99% of cases

Question 2

Describe the epidemiology of cervical cancer (rank, age group, incidence change over time)?

Answer 2

• 10^th most common cancer in woman in Scotland
• Peak age 45-55 years
• Incidence is decreasing (due to immunisation of HPV and screening)

Question 3

What are risk factors for cervical cancer?

Answer 3

• HPV infection
  
  • Causes 99% of cases
• Multiple sexual partners
• Older partner
• Smoking
• Deprived

Question 4

What is the presentation of cervical cancer?

Answer 4

• Abnormal vaginal bleeding
• Post coital bleeding
• Intermenstrual bleeding/PMB
• Discharge
• Pain – unusual though unless advanced cancer that has spread and is causes neuropathic pain

Question 5

How is cervical cancer diagnosed?

Answer 5

• Clinical
• Screen detected
• Biopsy

Question 6

What investigations are done for cervical cancer?

Answer 6

• Biopsy with histology
  
  • Majority squamous carcinoma (80%)
  • Adenocarcinoma (endocervical)
• PET CT, MRI to stage

Question 7

What histological type of cancer is most common for cervical cancer?

Answer 7

• Majority squamous carcinoma (80%)
• Adenocarcinoma (endocervical)

Question 8

How is cervical cancer staged?

Answer 8

• Done by PET-CT and MRI
• IA
  
  • Invasive cancer identified only microscopically
  • IA1 <=3mm depth and <=7mm diameter
  • IA2 <=5mm depth and >7 diameter
• IB
  
  • Clinical tumours confined to cervix

Spread:

• Locally (more common than metastases spread)
  
  • Stage 2 – vagina (upper 2/3)
  • Stage 3 – lower vagina, pelvis
  • Stage 4 – bladder, rectum
• Metastases
  
  • Lymphatic – pelvic nodes
  • Blood – liver, lung, bone

Question 9

Explain the staging of cervical cancer?

Answer 9

• IA
  
  • Invasive cancer identified only microscopically
  • IA1 <=3mm depth and <=7mm diameter
  • IA2 <=5mm depth and >7 diameter
• IB
  
  • Clinical tumours confined to cervix

Question 10

Where does cervical cancer often spread?

Answer 10

• Locally (more common than metastases spread)
  
  • Stage 2 – vagina (upper 2/3)
  • Stage 3 – lower vagina, pelvis
  • Stage 4 – bladder, rectum
• Metastases
  
  • Lymphatic – pelvic nodes
  • Blood – liver, lung, bone

Question 11

What lymph nodes does cervical cancer spread to?

Answer 11

Pelvic nodes

Question 12

Describe the management of cervical cancer?

Answer 12

• IA1
  
  • Type 3 excision of cervical transformation zone or hysterectomy
• IB-IIA
  
  • Radical hysterectomy (removal of uterus, cervix, upper vagina, parametria, pelvic nodes, ovaries are conserved in pre-menopausal woman) or chemo-radiotherapy
• IIB-IV
  
  • Chemo-radiotherapy

Question 13

What improves the prognosis of cervical cancer?

Answer 13

• Good cure rate if detected early