CERVICAL CANCER (SB)

Question 1

What are the primary risk factors for cervical cancer?

Answer 1

Early onset and frequent sexual contact, multiple sexual partners, history of STI, HPV infection, OCP use, smoking (SCCA), history of vulvar or vaginal dysplasia.

Question 2

What is the most common sexually transmitted infection associated with cervical cancer?

Answer 2

Human papillomavirus (HPV).

Question 3

What type of virus is HPV?

Answer 3

Double-stranded DNA virus that replicates within epithelial cells.

Question 4

Which HPV types are considered high risk and responsible for more than 70% of cervical cancers?

Answer 4

HPV 16 and HPV 18.

Question 5

What are the three types of HPV vaccines?

Answer 5

Bivalent (Cervarix), Quadrivalent (Gardasil), and Nonavalent (Gardasil 9).

Question 6

At what ages is HPV vaccination recommended?

Answer 6

Boys and girls aged 11-12 years (as early as 9 years), with catch-up vaccination recommended for females aged 13-26 who have not been previously vaccinated.

Question 7

What is the primary method of secondary prevention for cervical cancer?

Answer 7

Pap smear and HPV testing.

Question 8

Between what ages should routine cervical cancer screening be performed?

Answer 8

Ages 21-65.

Question 9

What is the recommended screening for women aged 21-29 years?

Answer 9

Pap testing every 3 years, no HPV testing.

Question 10

What is the recommended screening for women aged 30-65 years?

Answer 10

Co-testing with Pap and HPV testing every 5 years (preferred) or Pap testing alone every 3 years.

Question 11

Under what conditions can cervical cancer screening be discontinued in women over 65?

Answer 11

Three consecutive negative Pap smears or two consecutive negative HPV tests with no history of CIN 2+ in the past 20 years.

Question 12

What is the transformation zone in the cervix, and why is it significant?

Answer 12

The transformation zone is the area where the squamous epithelium of the ectocervix meets the columnar epithelium of the endocervix; it is the site where cervical cancer commonly develops.

Question 13

What is cervical intraepithelial neoplasia (CIN)?

Answer 13

A histologic diagnosis of precancerous lesions in the squamous epithelium of the cervix, graded as CIN 1, 2, or 3.

Question 14

Which CIN grade is most likely to regress spontaneously?

Answer 14

CIN 1.

Question 15

Which CIN grade is a precursor to invasive cancer?

Answer 15

CIN 3.

Question 16

What is the histologic characteristic of CIN 3?

Answer 16

Cellular atypia involves more than two-thirds of the epithelial layer with an increased nucleus-to-cytoplasm ratio and rapid cell division.

Question 17

What is the significance of atypical squamous cells of undetermined significance (ASC-US) on a Pap smear?

Answer 17

Atypical cells are present, but their significance is unclear. Follow-up includes repeat cytology at 12 months or HPV testing.

Question 18

What should be done if a patient has ASC-US and a positive HPV test?

Answer 18

Perform colposcopy.

Question 19

What is the preferred management for a patient with ASC-H (atypical squamous cells - cannot exclude high-grade lesion)?

Answer 19

Colposcopy to evaluate for CIN 2/3.

Question 20

What is the histologic correlation of low-grade squamous intraepithelial lesion (LSIL)?

Answer 20

LSIL is consistent with CIN 1.

Question 21

What is the management for a patient with LSIL and a negative HPV test?

Answer 21

Repeat HPV and Pap testing in 1 year.

Question 22

What is the next step for a patient with LSIL and a positive HPV test?

Answer 22

Perform colposcopy.

Question 23

What is the recommended management for CIN that persists for more than 2 years?

Answer 23

Excision procedure.

Question 24

What percentage of unmanaged CIN 2/3 cases progress to cervical cancer?

Answer 24

0.2

Question 25

What is the next step in the management of high-grade squamous intraepithelial lesion (HSIL)?

Answer 25

Colposcopy.

Question 26

What are the treatment options for HSIL depending on age and biopsy results?

Answer 26

Excision or ablation.

Question 27

What percentage of Pap tests show atypical glandular cells (AGC)?

Answer 27

Approximately 3 out of every 1000 Pap tests.

Question 28

What is the risk of underlying invasive cancer in patients with atypical glandular cells?

Answer 28

3% to 17%.

Question 29

What is the recommended evaluation for atypical glandular cells (AGC)?

Answer 29

Colposcopy with endocervical sampling.

Question 30

What additional test should be performed for patients over 35 years old with AGC?

Answer 30

Endometrial sampling.

Question 31

What risk factors indicate the need for endometrial sampling in AGC?

Answer 31

Unexplained vaginal bleeding, obesity, chronic anovulation (e.g., PCOS), or family history of Lynch syndrome.

Question 32

What is the first step in evaluating women with abnormal cytology?

Answer 32

Colposcopy.

Question 33

What is a colposcope?

Answer 33

A low-power binocular microscope with a light source used to examine the cervix.

Question 34

What solution is applied to the cervix during colposcopy to highlight abnormal areas?

Answer 34

Diluted 3-5% acetic acid.

Question 35

What does an acetowhite lesion on colposcopy indicate?

Answer 35

Possible dysplastic or cancerous cells.

Question 36

Why do dysplastic cells appear white after applying acetic acid?

Answer 36

Acetic acid dehydrates epithelial cells; dysplastic cells with large nuclei reflect light and appear white.

Question 37

When is a colposcopy considered 'satisfactory'?

Answer 37

When the entire transformation zone is visible and assessed.

Question 38

What is recommended if a colposcopy is 'unsatisfactory'?

Answer 38

Endocervical curettage (ECC).

Question 39

What are common hemostatic agents used after a cervical biopsy?

Answer 39

Ferric subsulfate (Monsel’s solution) or silver nitrate sticks.

Question 40

What are the two main types of treatment for cervical dysplasia?

Answer 40

Ablative and excisional procedures.

Question 41

What are the common ablative treatments for cervical dysplasia?

Answer 41

Cryotherapy and CO2 laser ablation.

Question 42

What is the most common method of excisional treatment for cervical dysplasia?

Answer 42

Loop Electrosurgical Excision Procedure (LEEP).

Question 43

What is the purpose of cold knife conization?

Answer 43

To excise the cervix for histopathologic examination and ensure clear margins.

Question 44

What is the most common histologic type of cervical cancer?

Answer 44

Squamous cell carcinoma (SCCA).

Question 45

What are the subtypes of squamous cell carcinoma of the cervix?

Answer 45

Large cell (keratinized or non-keratinizing), small cell, and verrucous carcinoma.

Question 46

What is the significance of verrucous carcinoma of the cervix?

Answer 46

Rare, resembles vulvar warty tumors, rarely metastasizes unless mixed with typical SCCA.

Question 47

What are the subtypes of adenocarcinoma of the cervix?

Answer 47

Endocervical, endometrioid, clear cell, adenoid cystic, and adenoma malignum.

Question 48

What is the worst prognostic subtype of adenocarcinoma?

Answer 48

Clear cell adenocarcinoma.

Question 49

Which cervical adenocarcinoma subtype is associated with diethylstilbestrol (DES) exposure?

Answer 49

Clear cell adenocarcinoma.

Question 50

What is the significance of adenoid cystic carcinoma of the cervix?

Answer 50

Aggressive, resembles basal cell carcinoma, more common in women over 60.

Question 51

What is adenoma malignum (minimal deviation adenocarcinoma)?

Answer 51

A rare, highly invasive mucinous adenocarcinoma with early metastasis.

Question 52

What is the mixed histologic type of cervical cancer?

Answer 52

Adenosquamous carcinoma.

Question 53

What is a particularly aggressive form of adenosquamous carcinoma?

Answer 53

Glassy cell carcinoma.

Question 54

Why is glassy cell carcinoma considered highly aggressive?

Answer 54

It metastasizes early to lymph nodes and distant sites, often leading to poor outcomes.

Question 55

What are the common clinical presentations of cervical cancer?

Answer 55

Abnormal bleeding, abnormal discharge, intermenstrual bleeding, postcoital bleeding, foul-smelling vaginal discharge.

Question 56

What are the three biopsy tools used for diagnosing cervical cancer?

Answer 56

Kevorkian, Eppendorf, Tischler.

Question 57

What imaging and diagnostic tests are used in clinical staging of cervical cancer?

Answer 57

Physical exam, chest X-ray (CXR), intravenous pyelography (IVP), CT scan.

Question 58

What is FIGO Stage 1 cervical cancer?

Answer 58

Cancer is confined to the cervix.

Question 59

What is FIGO Stage 2 cervical cancer?

Answer 59

Cancer has spread to the uterus, kidneys, or lower third of the vagina.

Question 60

What is FIGO Stage 3 cervical cancer?

Answer 60

Cancer has spread to lymph nodes.

Question 61

What is FIGO Stage 4 cervical cancer?

Answer 61

Cancer has metastasized to distant organs.

Question 62

What is the most common lymph node metastasis site for cervical cancer?

Answer 62

Parametrial lymph nodes.

Question 63

What are the three macroscopic appearances of cervical cancer?

Answer 63

Ulcerated, exophytic (cauliflower-like), endophytic.

Question 64

What is an endophytic cervical tumor?

Answer 64

A deeply invasive tumor that originates from the endocervix, filling the cervix and lower uterine segment (barrel-shaped cervix).

Question 65

What are the most important prognostic factors for cervical cancer?

Answer 65

Tumor size, lymph node involvement, and FIGO stage.

Question 66

What is the significance of tumor diameter in FIGO staging of stage I cervical cancer?

Answer 66

Stage IB1 is ≤4 cm, Stage IB2 is >4 cm.

Question 67

What is the primary management for Stage I-IIA cervical cancer?

Answer 67

Radical hysterectomy with bilateral lymphadenectomy or radiation therapy.

Question 68

What is the main treatment for Stage IIB, III, and IVA cervical cancer?

Answer 68

Chemoradiation.

Question 69

When is neoadjuvant chemotherapy used in cervical cancer?

Answer 69

Before surgery or radiation therapy.

Question 70

When is extended field radiation used in cervical cancer treatment?

Answer 70

When there is paraaortic lymph node involvement.

Question 71

What is the recommended follow-up schedule for cervical cancer survivors in the first 5 years?

Answer 71

Every 3 months for the first 2 years, every 6 months from years 3-5, then yearly after 5 years.

Question 72

What tests are included in follow-up monitoring for cervical cancer?

Answer 72

Physical exam, Pap smear, CXR, PET scan, renal function test.

Question 73

When do most cervical cancer recurrences occur?

Answer 73

Within 2 years.

Question 74

What is the main treatment for pelvic recurrence of cervical cancer?

Answer 74

Chemoradiation.

Question 75

What is pelvic exenteration?

Answer 75

An extensive surgical procedure for central pelvic tumor recurrence when curative treatment is possible.

Question 76

What is anterior pelvic exenteration?

Answer 76

Removal of the bladder, uterus, cervix, and all or part of the vagina.

Question 77

What is posterior pelvic exenteration?

Answer 77

Removal of the anus, rectum, uterus, cervix, and all or part of the vagina.

Question 78

What is total pelvic exenteration?

Answer 78

Removal of all pelvic contents.

Question 79

When is pelvic exenteration NOT performed?

Answer 79

For palliative purposes.

Question 80

What percentage of cervical cancer recurrences occur in the pelvis?

Answer 80

Approximately 50%.

Question 81

What imaging modality is useful in assessing pelvic recurrence?

Answer 81

Vaginal ultrasound scan.

Question 82

What are the treatment options for non-pelvic recurrence of cervical cancer?

Answer 82

Radiation, surgery, chemotherapy.

Question 83

When can localized non-pelvic recurrences be treated with radiation?

Answer 83

When they occur in areas not previously irradiated.

Question 84

When is metastasis resection considered in cervical cancer recurrence?

Answer 84

When a solitary metastasis occurs 3-4 years after primary therapy.