Cervical cancer

Question 1

What is the primary cause of cervical cancer and which HPV types are highest risk?

Answer 1

HPV infection (types 16 & 18); E6/E7 proteins inhibit p53/RB tumor suppressors

Question 2

How has cervical cancer incidence changed in the UK since the 1990s?

Answer 2

Dropped by 25% due to screening/vaccination

Question 3

What is the UK cervical screening protocol?

Answer 3

Pap smears every 3 years (25-49y) → every 5 years (50-64y). Reduces incidence/mortality by 80%

Question 4

What are 3 “red flag” symptoms of invasive cervical cancer?

Answer 4

Post-coital bleeding, intermenstrual/postmenopausal bleeding, vaginal discharge

Question 4

Simplified Cervical Cancer FIGO Staging

Answer 4

I= Confined to cervix

IIA= Invades upper 2/3 of vagina without parametrial involvement

IIB= Invades parametrium, but not pelvic wall

IIIA= Invades lower 1/3 of vagina, no pelvic wall

IIIB= Invades pelvic wall and/or causes hydronephrosis

IVA= Invades bladder/rectum

IVB= Distant metastases

A = Less Extensive Spread
B = More Extensive Spread

Question 4

What lesion precedes squamous cell carcinoma?

Answer 4

Cervical intraepithelial neoplasia (CIN I-III)

Question 5

What symptom suggests advanced disease?

Answer 5

Backache (hydronephrosis from nodal spread)

Question 6

What surgery is used for microinvasive cancer (<4cm)?

Answer 6

Wertheim’s hysterectomy (parametrium + nodes)

Question 7

What is the 5-year survival for Stage Ia vs. Stage IV?

Answer 7

Ia: ~100%; IV: 10-20%

Question 8

When do most relapses occur?

Answer 8

Within 5 years (late relapses rare)