Cervical cancer and cervical screening

Question 1

What other cancers can high-risk HPV cause?

Answer 1

Cervical
Penis
Vulva/vagina
Anus
Mouth
Oropharynx

Question 2

What is the peak age for cervical cancer?

Answer 2

45-55

Question 3

Which HPVs are high risk for cervical cancer?

Answer 3

16 & 18

Question 4

What are the risk factors for cervical cancer?

Answer 4

Multiple partners
Early age at first intercourse
Older age of partner
Smoking

Question 5

What are cervical cancer symptoms?

Answer 5

Abnormal vaginal bleeding
Post coital bleeding
Intermenstrual bleeding/PMB
Discharge
Pain
Often asymptomatic

Question 6

How is cervical cancer diagnosed?

Answer 6

Screen detected

Biopsy

Question 7

What does screening aim to detect?

Answer 7

Pre-cancerous disease NOT cancer

Question 8

What are the two types of cervical cancer?

Answer 8

Squamous cell carcinoma

Adenocarcinoma

Question 9

What type of cervical cancer are the majority?

Answer 9

Squamous carcinoma

Question 10

What is the staging for cervical cancer?

Answer 10

1A - 4B

Question 11

What is stage 1A1 cervical cancer?

Answer 11

Invasive cancer identified only microscopically

<3mm depth and <7mm diameter

Question 12

What is stage 1A2 cervical cancer?

Answer 12

<5mm depth

<7mm diameter

Question 13

What is stage 1B cervical cancer?

Answer 13

Confined to cervix

Question 14

What is stage 2 cervical cancer?

Answer 14

Upper 2/3 vagina

Question 15

What is stage 3 cervical cancer?

Answer 15

Lower vagina, pelvis

Question 16

What is stage 4 cervical cancer?

Answer 16

Bladder, rectum

Question 17

What is the lymphatic metastasis of cervical cancer?

Answer 17

Pelvic nodes

Question 18

What is the systemic metastasis of cervical cancer?

Answer 18

Liver, lungs, bone

Question 19

What investigations are used for cervical cancer staging?

Answer 19

PET-CT

MRI

Question 20

What is the treatment for stage 1A cervical cancer?

Answer 20

Hysterectomy

Excision of cervical TZ

Question 21

What is the treatment for stage 1B-2A cervical cancer?

Answer 21

Radical/total hyseterectomy
OR
Chemoradiotherapy

Question 22

What is the treatment for stage 2B-4 cervical cancer?

Answer 22

Chemoradiotherapy

Question 23

What does radical hysterectomy involve?

Answer 23

Removal of: uterus, cervix, upper vagina, parametria, pelvic nodes
Ovaries conserved
Exploration of pelvic and para-aortic space

Question 24

What is the radiotherapy treatment for cervical cancer?

Answer 24

External beam x 20 fractions

Question 25

What is the chemotherapy for cervical cancer?

Answer 25

5 cycles cisplatin

Question 26

What are the options for cervical cancer treatment?

Answer 26

``` Hysterectomy Radiotherapy Chemotherapy Chemoradiotherapy Caesium insertion ```

Question 27

What is the most important cause of cervical cancer?

Answer 27

HPV

Question 28

What less common cancers can HPV cause,?

Answer 28

``` Cervix Penis Vulva/vaginal Anus Mouth Oropharynx ```

Question 29

Who has been vaccinated against HPV?

Answer 29

Girls born after 1 September 1990

Question 30

What type of cancers are cervical cancers mainly?

Answer 30

Squamous cell carcinoma

Question 31

What is the SCCRS?

Answer 31

Scottish Cervical Call Recall System (SCCRS)

Question 32

If there are minor changes on cervical screening what is the next step?

Answer 32

Colposcopy

Question 33

What age group is cervical screening aimed at?

Answer 33

25-65

Question 34

How often do you have a cervical screening?

Answer 34

Every 5yrs

Question 35

What type of test is cervical screening?

Answer 35

Liquid based cytology (LBC)

Question 36

Where are the cells taken from in the cervix?

Answer 36

Transformation zone

Question 37

What does abnormal cells on cervical screening mean?

Answer 37

Cervical intraepithelial neoplasia (CIN)

Question 38

What type of epithelium is typically in the endocervix?

Answer 38

Columnar epithelium

Question 39

What type of epithelium is typically in the ectocervix?

Answer 39

Squamous epithelium

Question 40

What type of epithelium is typically in the transformation zone?

Answer 40

Squamo-columnar as is junction between two

Question 41

What method stains cervical samples?

Answer 41

Papanicolaou method (PAP)

Question 42

What is it called when the cytology of the cervix is abnormal?

Answer 42

Dyskaryosis

Question 43

What does the grading of dyskaryosis mean?

Answer 43

Degree of underlying CIN - low grade - high grade

Question 44

What cells reflect HPV infection?

Answer 44

Koilocytes

Question 45

Which test is more sensitive HPV test or cytology?

Answer 45

HPV test

Question 46

What is used in colposcopy to identify limits of lesion?

Answer 46

Acetic acid

Question 47

What is done to make diagnosis of cervical cancer/CIN?

Answer 47

Punch biopsy

Question 48

What cells does HPV infect in the transformation zone?

Answer 48

Basal layer cells

Question 49

What does koilocytosis look like?

Answer 49

Cells with wrinkled nuclear and perinuclear halo

Question 50

What are low risk types of HPV?

Answer 50

6, 11, 42, 44

Question 51

What are high risk types of HPV?

Answer 51

16, 18, 31, 45

Question 52

What are low grade types of HPV?

Answer 52

Genital warts and low grade CIN

Question 53

What are high grade types of HPV?

Answer 53

High grade CIN | Cancer

Question 54

How does HPV cause high grade CIN?

Answer 54

Deregulation of host cell cycle

Question 55

What are the 3 grades of CIN?

Answer 55

CIN 1: low grade dysplasia CIN 2: moderate dysplasia CIN 3: severe dysplasia - unlikely to regress

Question 56

What is cervical intraepithelial neoplasia (CIN)?

Answer 56

Disorganised proliferation of abnormal cells in squamous epithelium

Question 57

What is the treatment for CIN?

Answer 57

LLETZ Thermal coagulation Laser ablation

Question 58

What are the risks of CIN?

Answer 58

Increased risks of cervical cancer compared with normal population