Epidemiology and Aetiological - Cervical cancer

Question 1

How common is cervical cancer in women?

Answer 1

4th most common cancer type in women worldwide - 12/13th most common in UK

Question 2

How many new cases each year?

Answer 2

> 500,000 new cases each year with 75% in the developing world

Question 3

What is the percentage of women dying from cervical cancer that have never had screening?

Answer 3

60-90%

Question 4

What is the percentage of women dying from cervical cancer that have poor access to prevention, screening and treatment?

Answer 4

90%

Question 5

How many cases of carcinoma in-situ diagnosed in 2016?

Answer 5

Approx 26,500 cases

Question 6

How many cases of invasive cancer in 2016 UK? How many were considered to be preventable?

Answer 6

3,200 cases, 99.8%

Question 7

What age is cervical cancer the most common cancer in UK?

Answer 7

<35 years old

Question 8

In what age group are 52% of new tumours are diagnosed?

Answer 8

<45 year olds

Question 9

How much have incidence rates decreased since the 1990s?

Answer 9

24%

Question 10

In 2017, how many deaths occurred?

Answer 10

850

Question 11

How much lower are the death rates compared to the early 1970’s?

Answer 11

72% lower

Question 12

How much are mortality rates expected to fall by 2035?

Answer 12

7% - however an expected increase in incidence of 43% over the same period

Question 13

Without the national screening programme how many possible deaths per year?

Answer 13

6,000

Question 14

What is the cost per life saved estimated at?

Answer 14

£36,000

Question 15

How common is cervical cancer in European women?

Answer 15

16th most common cancer

Question 16

How many new European cases and deaths in 2018?

Answer 16

Approx 61,000 cases & 26,000 deaths

Question 17

In which country are the highest incidence rates?

Answer 17

Romania

Question 18

In which country has the lowest incidence rates?

Answer 18

Switzerland

Question 19

How many people worldwide were diagnosed with cervical cancer in 2018?

Answer 19

570,000

Question 20

Where are incidence rates highest worldwide?

Answer 20

South Africa

Question 21

Where are incidence rates lowest worldwide?

Answer 21

Western Africa

Question 22

What is the highest risk factor?

Answer 22

Infection with HPV

Question 23

How many cases are HPV 16 & 18?

Answer 23

70%

Question 24

What do almost all cervical cancers contain

Answer 24

HPV DNA

Question 25

Does most HPV progress to CIN?

Answer 25

No

Question 26

Risk factors increasing likelihood of progression include what?

Answer 26

HPV genotype Early age at first intercourse Long duration of most recent sexual relationship Cigarette smoking

Question 27

What other risk factors are there?

Answer 27

Infection with HIV and infection with other STDs Smoking linked to SCC Contraceptive pill Number of children Age at first pregnancy Family history Previous cancer Living in a deprived area

Question 28

What percentage are squamous cell carcinomas and where do they originate from?

Answer 28

85% originating from the transformation zone

Question 29

What percentage are adenocarcinomas?

Answer 29

5-10%

Question 30

A small proportion are rare tumours, what are these?

Answer 30

Sarcomas, mixed adenosquamous and adenocanthomas

Question 31

Where is the transformation zone located?

Answer 31

Squamocolumnar junction where vagina and cervix meet

Question 32

What happens in the transformation zone?

Answer 32

Many invasive carcinomas arise from a progressive range of pre-malignant epithelial changes starting at the squamocolumnar junction where the vagina and cervix meet

Question 33

What is dyskaryosis?

Answer 33

Abnormal nucleus

Question 34

What is dysplasia?

Answer 34

Abnormal growth of cells/tissues

Question 35

What percentage of in-situ tumours will develop into invasive cancer?

Answer 35

30-40%

Question 36

CIN I is what in thickness?

Answer 36

1/3rd thickness

Question 37

CIN II is what in thickness?

Answer 37

2/3rd thickness

Question 38

CIN III is what in thickness?

Answer 38

Full thickness (Ca in situ)

Question 39

Symptoms of invasive cancer include what?

Answer 39

Vaginal bleeding (80%) Unusual discharge Dyspareunia - pain during sex Abdo or lower back pain Infiltration and destruction of structures Haematuria Diarrhoea Tenesmus Fistula Compression of ureters Renal failure with urgemia

Question 40

What investigations occur?

Answer 40

Medical history Palpation Visual inspection of the cervix Coloposcopy Endocervical scraping Cone biopsy Chest x-ray CT, MRI or PET scan

Question 41

What are exophytic lesions?

Answer 41

Growth of tumour outwards

Question 42

What are infiltrative lesions?

Answer 42

Cancer spread beyond layer of tissue in which it developed and is growing into surrounding, healthy tissues

Question 43

How do exophytic lesions appear?

Answer 43

Bulky and polypoidal

Question 44

How do infiltrative lesions appear?

Answer 44

Infiltrative lesions may be less visible as abnormal growth is directed inward, in a larger lesion the cervix and upper vagina may be replaced by malignant ulcer

Question 45

What staging is used for gynaecologist tumours?

Answer 45

FIGO (The International Federation of Gynaecology and Obstetrics 1974) - unusual to see TNM