Cervical Cancer

Question 1

Strongest risk factor for cervical cancer?

Answer 1

HPV 16 & 18 infection

Question 2

What cells cause cervical cancer?

Answer 2

Squamous cell = 80%

Adenocarcinoma = 20%

Question 3

Where does squamous cell carcinoma arise from in cervical cancer?

Answer 3

Vaginal cervix

Question 4

Where does adenocarcinoma arise from in cervical cancer?

Answer 4

Endocervix

Question 5

What is the pathology of HPV infection?

Answer 5

Turns on oncoproteins E6/E7

Question 6

What do oncoproteins E6/E7 lead to?

Answer 6

Cervical intra-epithelial neoplasia

Question 7

Which part of the cervix is most susceptible to malignant change?

Answer 7

Squamo-columnar junction

Question 8

What are the peak ages of cervical cancer?

Answer 8

30 - 39

> 70

Question 9

What other risk factors account for the 3% of non HPV cervical cancer?

Answer 9

Multiple partners

Early first intercourse

Question 10

Typical presentation?

Answer 10

” 68 y/o presents with weight loss, fatigue and pelvic pain. Vaginal exam shows an exophytic mass. “

Typically, cervical cancer is found by an abnormal smear and has an asymptomatic presentation.

Question 11

DDx of abnormal smear?

Answer 11

Cervical ectropian

Nabothian cyst

Cervical polyp

Cervicitis

Question 12

What is a cervical ectropian?

Answer 12

Natural descent of the cervix due to hormones. Cervix appears red

Question 13

Investigation?

Answer 13

Speculum exam
- Often bleeds when prodded –> post-coital bleeding

Colposcopy

Biopsy

MRI pelvis

Question 14

What may be elicited by colposcopy?

Answer 14

Dense acetic acid uptake

Question 15

What is acetic acid used for normally in colposcopy?

Answer 15

Washing away mucus

Question 16

What staging is used for cervical cancer?

Answer 16

FIGO staging

Question 17

Stage 1 FIGO for cervical?

Answer 17

Cancer in situ
A - invisible - diagnosed by biopsy
B - visible but very small

Question 18

Stage 2 FIGO for cervical?

Answer 18

Cancer invades past cervix but not to pelvic sidewall

Question 19

Stage 3 FIGO for cervical?

Answer 19

Tumour fixed to pelvic wall
A - involves vagina
B - traverse to internal pelvic wall

Question 20

Stage 4 FIGO for cervical?

Answer 20

A - local spread

B - distant spread

Question 21

Treatment of carcinoma in situ?

Answer 21

LLETZ

- Large loop excision of transitional zone

Question 22

Stage 2 treatment?

Answer 22

Hysterectomy

Question 23

Stage 3 treatment?

Answer 23

Chemo
- Cisplatin

Radiotherapy

Question 24

Stage 4 treatment?

Answer 24

Palliative chemo

• Paclitaxel
• Cisplatin