Cervical cancer

Question 1

What is the distribution of incidence for cervical cancer?

Answer 1

Bimodal: 25-29 and >80 peak

Question 2

List two risk factors for cervical cancer

Answer 2

HPV 
smoking
COCP use
multiple sexual partners
immunosuppression

Question 3

Which HPV subtypes are implicated in cervical cancer?

Answer 3

16 and 18

Question 4

When do vaccinations take place for HPV?

Answer 4

11-13 girls (boys as well for herd immunity)

Question 5

Which vaccination is given and against which HPV strains is it effective?

Answer 5

GARDISAL

HPV 6,11,16,18

Question 6

What is the minimum protection?

Answer 6

10 years

Question 7

What is the screening age and rate of screening?

Answer 7

25-65y
25-49 every 3 years
>50 every 5 years

Question 8

What are the two cell types in the cervix?

Answer 8

endocervix- columnar epithelium

ectocervix- squamous epithelium

Question 9

Where does cervical cancer occur?

Answer 9

transitional zone, between columnar and squamous epithelium. This is a physiological site of metaplasia, however HPV interferes with this process

Question 10

If an abnormal cervix is observed during smear test, what should be done?

Answer 10

smear is inappropriate- require biopsy

Question 11

Name two modalities of biopsy for CC?

Answer 11

punch

LLETZ- large loop excision of transformation zone

Question 12

Name two indications for colposcopy referral

Answer 12

abnormal screening smear

suspcious symptoms/abnormal cervix

Question 13

How are pathological changes viewed with the colposcopy?

Answer 13

application of acetic acid which highlight mosaisicsm, abnormal vessels, and acetowhite appearance

Question 14

What are the types of CIN?

Answer 14

CIN 1= low grade

CIN 2 and CIN3= high grade

Question 15

Which CIN types require treatment?

Answer 15

CIN2 and 3

not CIN1- monitor

Question 16

What are the treatment options for high grade CIN?

Answer 16

destructive= cold coagulation, cryotherapy

excisional= LLETZ, laser, cold knife cone

Question 17

If patient displays high grade CIN, what is their follow up after treatment?

Answer 17

6 months with high risk HPV test

Question 18

What is the most common type of cervical cancer?

Answer 18

squamous cell carcinoma

Question 19

List two types of cervical cancer?

Answer 19

squamous cell carcinoma
adenocarcinoma
adenosquamous carcinoma
endometriod
serous

Question 20

Name two typical presentations of cervical cancer

Answer 20

unschedueled vaginal bleeding
offensive vaginal discharge
supraclavicular lymph node
obstructive renal failure

Question 21

Why are U+Es particularly important when investigating cervical cancer?

Answer 21

due to anatomical compression of ureters from cervical mass

Question 22

List three aspects of CC diagnosis

Answer 22

Lymph node exam- supraclavicular
abdo exam
speculum
bimanual
PR
colposcopy

Question 23

Why is a PR conducted?

Answer 23

to assess parametrium

Question 24

List two imaging modalities for CC

Answer 24

MRI>CT

PET-CT for staging

Question 25

What is the parametrium?

Answer 25

band of fibrous tissue that separates the supravaginal portion of the cervix from the bladder.

Question 26

Name one poor prognostic factor

Answer 26

lymph node involvement lymphovascular space parametrial extension

Question 27

What is the management of CC?

Answer 27

surgery- simple vs radical chemo radiotherapy

Question 28

Which chemo agent is used?

Answer 28

cisplatin

Question 29

Name two fertility conserving surgeries?

Answer 29

LLETZ Trachelectomy= cervix, upper vagina and parametrium removal Laparscopic lymphadenectomy pelvic lymph nodes

Question 30

Does radical hysterectomy via open surgery or laparoscopy have the better outcome?

Answer 30

open surgery

Question 31

A 60 year old female has never had a cervical smear test but has only had one sexual partner her whole life. Are you worried about cervical cancer?

Answer 31

very unlikely...