Cervical Cancer

Question 1

List some of the risk factors for Cervical cancer

Answer 1

HPV (Typically 16&16)
Smoking
HIV
Increased estrogen

Question 2

What is the therapy used during colposcopy

Answer 2

LLETZ
large loop excision of transformation zone

Question 3

What determined the formation of transformation zone (2)

Answer 3

Direct in growth of original squamous epithelium bordering the columnar epithelium

Squamous metaplasia- Proliferation of undifferentiated subcolumnar reserve cellls into squamous epithelium.

Question 4

How often must women be screened for cervical cancer

Answer 4

Over age 30, 3 free Pap smears 10 years apart
Annually for HIV + women

Question 5

Which HPV types are commonly associated with genital warts and skin infections (2)

Answer 5

HPV 6 and 11

Question 6

Which HPV types are associated with cervical cancer (2)

Answer 6

HPV 16 and 18

Question 7

How would you manage a patient with Pap smear showing ASCUS

Answer 7

If cervix is normal and asymptomatic pt treat obvious infx of Lower genital tract
Repeate Pap In 12 months
If same dx three times conservatively refer for colposcopy

Question 8

How would you manage a patient with Pap smear showing ASC-H

Answer 8

Refer for colposcopy

Question 9

How would you manage a patient with Pap smear showing LSIL

Answer 9

Repeat two Pap smear on 2 ocasions 6-12 months apart. If persists, colposcope

Question 10

How would you manage a patient with Pap smear showing HSIL

Answer 10

Colposcopy

Question 11

What is colposcopy

Answer 11

Cervix is magnified and illuminated after application of 3-5% acetic acid

Question 12

What is the criteria for therapeutic intervention in woman screened positive for cervical cancer (5)

Answer 12

See booklet (pg 79)

1. Diagnostic modalities of abnormal cervix all show same results
2. The entire extent of abnormal area can be identified
   3.There is no evidence of occult micro invasion
3. The endocervix is normal on cytology
4. There is available colposcope for pt with abnormal Pap

Question 13

What is the criteria for diagnostic cone biopsy (5)

Answer 13

There is no:

1. Diagnostic modalities of show disparities
2. The entire extent of abnormal area cannot be identified
   3.There is evidence of occult micro invasion
3. The endocervix is abnormal on cytology
4. Abnormal cells on cytology
5. There is available colposcope for pt with abnormal Pap

(Opposite of everything above basically)

Question 14

Differences between LLETZ and cone biopsy (2)

Answer 14

LLETZ is for therapeutic interventions and cone biopsy is for diagnostic

LLETS excisions is 7-10mm and cone biopsy takes 2.5cm

Question 15

Which vaccine can you give for HPV 16 and 18

Answer 15

Cervarix

Question 16

Which vaccine can you give for HPV 6 and 11

Answer 16

Gardasil

Question 17

List the classification of cervical cancer (3)

Answer 17

Squamous cell carcinoma
Adenocarcinoma
Other epithelial tumours

Question 18

Outline the FIGO classification of cervical cancer

Answer 18

1 (cancer strictly confined to cervix)
A: less of equal to 5mm
B: more than 5mm

2. (Extends beyond cervix but not to pelvic side wall)
   A: Cancer extends beyond cervix but not to pelvic wall, involves upper third of vagina
   B: parametral but not to pelvic side wall

3 (Extends to pelvic side wall)
A: involved lower third of vagina
B:Extends to pelvic side wall

4
A: Spreads to adjacent organs
B: Spread to distant organs

Question 19

Outline the clinical presentation of a woman with cervical cancer (5/6)

Answer 19

Asymptomatic
Abnormal bleeding
Offensive discharge
Pelvic pain
Malignant vesical or rectal fistula
Symptoms die to metastasis

Question 20

Discuss the treatment options according to the staging of cervical cancer

Answer 20

Stage 1A: Hysterectomy and pelvic lymphadenectomy

Stage 1B: Radical hysterectomy and bilateral pelvic lymphadenectomy (involves cutting off uterus, vagina at 2cm and both parametric and lymph nodes)

Stage 1B2: Primary radical chemoradiation

Stage 2 and 3: Primary radical chemotheradiation
Stage 4: palliative radiotherapy