Cervical Screening and Cancer

Question 1

What type is most common?

What is it very strongly associated with?
→ Which strains of this in particular?

What is its pre-malignant condition called?

Answer 1

➊ 80% are squamous cell carcinomas – Adenocarcinoma is 2nd

➋ HPV infection
→ Types 16 and 18

➌ Cervical Intraepithelial Neoplasia (CIN)

Question 2

What are its risk factors?

How does it present?

What will be seen O/E?

Answer 2

➊ • Increased risk of HPV – No vaccination, Multiple sexual partners, Lack of protection
• Non-engagement with cervical screening - Late detection of any dysplastic changes
• Smoking
• Immunosuppression e.g. HIV
• COCP use for 5+ yrs
• Increased number of full-term pregnancies

➋ • Most asymptomatic and picked up on screening
• Abnormal uterine bleeding (Intermenstrual, Postcoital, Postmenopausal)
• Vaginal discharge
• Pelvic pain
• Dyspareunia

➌ Ulceration, Inflammation, Bleeding, Visible tumour

Question 3

What occurs in the screening programme?

How is it investigated?

What staging system is used?
→ How does each stage differ?

Answer 3

➊ Cervical smear offered to women:
• Every 3 yrs if 25-49 yrs
• Every 5 yrs if 50-64 yrs
• Every yr if HIV

➋ • Colposcopy – Get biopsy (via LLETZ – excision of transition zone)
• Staging CT CAP

➌ FIGO Staging
→ • Stage 1 – Confined to cervix – 5 yr survival ~ 98%
• Stage 2 – Invades uterus or upper 2/3 of vagina
• Stage 3 – Invades pelvic wall or lower 1/3 of vagina
• Stage 4 – Invades bladder, rectum or beyond pelvis – 5 yr ~ 15%

Question 4

How is it managed?

Answer 4

• CIN and Early Stage 1A – LLETZ or Cone biopsy
• Stage 1B – 2A – Radical hysterectomy and removal of local lymph nodes with chemoradiotherapy
• Stage 2B – 4A – Chemoradiotherapy
• Stage 4B – Combination of everything, but leaning more towards Palliative