CIN and Cervical Cancer

Question 1

How often do a) 25-29yrs b) 30-65yrs and c) high risk patients undergo cervical screening?

Answer 1

a) Every 3 years
b) Every 5 years
c) Annually

Question 2

What are benefits of liquid cytology vs conventional cytology?

Answer 2

1. Higher sensitivity (80-90%)
2. Less frequent screening
3. Computer-assisted
4. Tests for HPV, chlamydia, gonorrhoea

Disadvantage = more expensive

Question 3

What are the three grades in the Bethesda classification of cervical cytology?

Answer 3

i) low grade squamous intraepithelial lesion (LSIL)
ii) high grade squamous intraepithelial lesion (HSIL)
iii) query squamous cell carcinoma

Question 4

What is ASCUS?

Answer 4

Atypical squamous cells of undetermined significance (test for HPV - colposcopy)

Question 5

Where does HPV typically affect?

Answer 5

Cells at the transitional zone

Question 6

What does HPV 6,11 cause?

What does HPV 16,18 cause?

Answer 6

Genital warts

Cervical cancer

Question 7

How is CIN graded?

Answer 7

CIN 1 (mild)
CIN 2 (moderate)
CIN 3 (severe)
Carcinoma in situ
Invasive carcinoma

Question 8

What are risk factors for CIN?

Answer 8

1. Multiple sexual partners
2. High risk sexual partner
3. Smoking
4. Immunocompromised
5. Low socioeconomic class

Question 9

What are the two types of technique used to treat CIN?

Answer 9

Ablation (cryotherapy, laser ablation)
Excision (LLETZ, laser cone excision, cold knife conisation)

Question 10

What are the complications of LLETZ?

Answer 10

Bleeding
Infection
Vasovagal
Cervical stenosis
Cervical incompetence

Question 11

What are the two types of cervical cancer? Which HPV strain causes which?

Answer 11

Squamous cell carcinoma (HPV 16) - 90%
Adenocarcinoma (HPV 18) - 10%

Question 12

What lymph nodes does cervical cancer spread to?

Answer 12

Parametrial nodes

Question 13

What are the symptoms of cervical cancer?

What are the examination findings?

Answer 13

Intermenstrual/post-coital/post-menopausal bleeding, pelvic pain, systemic symptoms

Hard, glandular erosion/ulceration
Contact bleeding
Intense acetowhite uptake

Question 14

How is cervical cancer diagnosed?

Answer 14

Colposcopy + punch biopsy
CT/MRI abdo pelvis (staging)
EUA

Question 15

What is the FIGO staging of cervical cancer?

Answer 15

1 Confined to cervix
2 Involves proximal 2/3 of vagina
3 Spread to pelvis
4 Distant metastases

Question 16

How is stage 1a treated?
How is stage 1b-2a treated?
How is stage 2b-4a treated?

Answer 16

1a → LLETZ ± simple hysterectomy ± radiotherapy

1b-2a → radical hysterectomy ± bilateral lymphadenectomy ± radiotherapy

2b-4a → radiotherapy ± chemo

Question 17

What is involved in a radical hysterectomy?

Answer 17

Total abdominal hysterectomy + bilateral salpingo-oophorectomy + paracervical tissue + vaginal cuff + lymph nodes

Question 18

What is involved in a simple hysterectomy?

Answer 18

Uterus + cervix