Gynaecological Cancer - Cervical Cancer

Question 1

Histopathology of Cervical Cancer (3).

Answer 1

1. 80% - Squamous Cell Carcinoma.
2. Next Majority - Adenocarcinoma.
3. Rare Types.

Question 2

Pathophysiology of Cervical Cancer (3).

Answer 2

1. Infection with Human Papillomavirus (HPV) - STI.
2. Type 16 and Type 18 are responsible for 70% of cases.
3. p53 and pRb (Tumour Suppressor genes) are inhibited respectively by E6 and E7 proteins produced by HPV.

Question 3

Risk Factors of Cervical Cancer (A4, H).

Answer 3

A : Increased Risk of Catching HPV.
1. Early Sexual Activity.
2. Increased Number of Sexual Partners.
3. Sexual Partners with More Partners.
4. Not Using Condoms.
B : Later Detection of Precancerous/Cancerous Changes (Poor Engagement with Screening).
C: Smoking.
D : HIV.
E : COCP.
F : Number of Full-Term Pregnancies.
G : Family History.
H : Exposure to Diethylstilbestrol (used to prevent miscarriages before 1971).

Question 4

Clinical Presentation of Cervical Cancer (5).

Answer 4

Non-Specific Symptoms :
1. Abnormal Vaginal Bleeding - Intermenstrual, Postcoital, Postmenopausal.
2. Vaginal Discharge.
3. Pelvic Pain.
4. Dyspareunia.
5. Asymptomatic.

Question 5

Investigations of Cervical Cancer.

Answer 5

1. Cervical Examination with Speculum and Swabs.
2. Colposcopy : Ulceration, Inflammation, Bleeding, Visible Tumour.
3. 2 Week Wait Referral.

Question 6

Cervical Intraepithelial Neoplasia.

Answer 6

CIN I : Mild Dysplasia (1/3 of Thickness of Epithelial Layer Affected) - Return to Normal if Untreated.
CIN II : Moderate Dysplasia.
CIN III : Severe