Cervical cancer

Question 1

what is the appearance of normal ectocervix

Answer 1

basal membrane with stromal cells

cells at top have large cytoplasm with small nucleus

Question 2

what is the appearance of normal endocervix

Answer 2

lined by a single layer of glandular epithelium and row of nuclei

Question 3

what area in the cervix is most likely to be affected by dysplastic change

Answer 3

transformation zone (squamocolumnar junction)

Question 4

what are the neoplastic changes that occur in the cervix

Answer 4

CIN

cervical cancer - either squamous carcinoma or adenocarcinoma

Question 5

what is CIN

Answer 5

cervical intraepithelial neoplasia

precursor lesion for cervical squamous carcinoma

Question 6

list the risk factors for cervical neoplasia

Answer 6

HPV - particularly type 16 and 18
many sexual partners
sex from a young age - vulnerable SC junction
long term use of oral contraceptives
smoking
immunosuppression
lack of using barrier contraception methods

Question 7

describe the histology findings of HPV in a smear

Answer 7

thickened papillomatous squamous epithelium with cytoplasmic vacuolation
presence of koilocytes - epithelial cells with darker, larger nuclei present

Question 8

how long does it take for HPV infection to turn to high grade CIN

Answer 8

6 months - 3 years

Question 9

how long does it take for high grade CIN to turn to invasive cancer

Answer 9

5-20 years

Question 10

what is CIN

Answer 10

pre-invasive stage of cervical cancer

occurs at transformation zone, dysplasia of squamous cell

Question 11

does CIN have any symptoms

Answer 11

no - this is why it requires detection through cervical smear

Question 12

describe the histology of CIN

Answer 12

delay in maturation, more immature cells at top of epithelium
hyperchromasia
increased nucleocytoplasmic ratio
pleomorphism

Question 13

what is CIN I

Answer 13

basal 1/3 occupied by abnormal epithelium

Question 14

what is CIN II

Answer 14

abnormal cells extended to middle 1/3 of epithelium

Question 15

what is CIN III

Answer 15

abnormal cells occupy full thickness of the epithelium, also called carcinoma in situ

Question 16

when does CIN become cervical squamous carcinoma

Answer 16

when there is a breach /invasion of the stroma

Question 17

what cervical cancer is more common, squamous cell or adenocarcinoma

Answer 17

squamous cell, makes up 75% of cervical tumours

Question 18

what is the most common symptom of cervical cancer

Answer 18

abnormal uterine bleeding - either postmenopausal, post-coital or contact bleeding on examination

Question 19

list the symptoms of a more advanced cervical cancer

Answer 19

pelvic pain
ureteric obstruction
haematuria/UTI

Question 20

where might a cervical cancer locally invade

Answer 20

uterine body, vagina, bladder, uterus, rectum

Question 21

how might a cervical cancer spread via lymphatics

Answer 21

pelvic and para-aortic nodes

Question 22

how might a cervical cancer spread haematogenously

Answer 22

liver
bone
lung

Question 23

what cell type does a CGIN originate from

Answer 23

from endocervical epithelium only

Question 24

what is CGIN a precursor lesion for

Answer 24

cervical adenocarcinoma

Question 25

what is harder to diagnose on a smear test CIN or CGIN

Answer 25

CGIN as less likely the region that is swabbed

Question 26

what are the risk factors for cervical adenocarcinoma

Answer 26

later onset of sexual activity smoking HPV especially type 18

Question 27

if patient has an abnormal smear test what happens next

Answer 27

if HPV positive repeat in 6 months if mild dyskaryosis repeat in 6 months as can regress if mod-severe dyskaryosis refer for colposcopy if appearance is invasive, refer for colposcopy within 2 weeks

Question 28

when do women receive smear tests

Answer 28

25-49 every 3 years | 50-65 every 5 years

Question 29

what level of CIN requires an excisional biopsy following colposcopy

Answer 29

CIN II or above

Question 30

outline the management of low risk cervical cancer (stages IA-IA2)

Answer 30

cured through local excision, IA2 has a small risk of nodal involvement so pelvic lymphadenactomy may be offered

Question 31

outline the management of moderate risk cervical cancer (IB-IIA)

Answer 31

radical hysterectomy + pelvic lymphadenectomy, oophrectomy can be performed by rarely spreads to the ovaries radical radiotherapy + cisplastin are alternatives to surgery

Question 32

outline the management of stages IIB-IV of cervical cancer

Answer 32

usually radical radiotherapy + cisplastin chemotherapy

Question 33

what is a simple hysterectomy

Answer 33

removal of uterus, cervix and fallopian tubes

Question 34

what is a radical hysterectomy

Answer 34

removal of uterus, cervix, fallopian tubes + top 2cm of the vagina and tissues around the cervix

Question 35

list some side effects of radiotherapy targeted at the cervix

Answer 35

cystitis, diarrhoea, fibrosis causing vaginal stenosis and sexual dysfunction

Question 36

what is brachytherapy

Answer 36

insertion of radiotherapy directly into the body specifically targeting the desired area, sparing the surrounding organs