Uterine and Cervical Tumours

Question 1

What virus is one of the main causes of cervical cancer?

Answer 1

HPV – mainly 16 & 18

Question 2

Is the OCP protective against or a risk factor for cervical cancer

Answer 2

A risk factor

Question 3

What is the most common type of cervical cancer?

Answer 3

Squamous carcinoma

Question 4

Where in the cervix does cervical cancer most commonly occur?

Answer 4

The transformation zone

Question 5

How long does it take for a high grade CIN to become an invasive cancer?

Answer 5

5-20 years

Question 6

Who is currently offered the HPV vaccine in Scotland

Answer 6

Girls S1-3 and MSM <45

Question 7

What is the precursor to squamous carcinoma of the cervix?

Answer 7

Cervical intraepithelial neoplasia (CIN)

Question 8

What is the difference between CIN I, CIN II & CIN III

Answer 8

• CIN I = Basal 1/3 of epithelium occupied by abnormal cells – unlikely to progress to cancer
• CIN II = Abnormal cells extend to middle 1/3 – may progress to cancer
• CIN III – Abnormal cells occupy full thickness of epithelium – likely to progress to cancer

Question 9

What is the precursor to adenocarcinoma of the cervix?

Answer 9

Cervical glandular intraepithelial neoplasia (CGIN)

Question 10

Who is most at risk of vulvar carcinoma?

Answer 10

Elderly women

Question 11

What cancer classically presents with a crusting rash on the vulva?

Answer 11

Vulvar paget’s disease (cancer arising from the sweat glands)

Question 12

What age range is most at risk for endometrial cancer?

Answer 12

50-60

Question 13

What is the most common type of uterine cancer?

Answer 13

Adenocarcinoma

Question 14

Which is the more common uterine cancer, endometrial carcinoma or serous carcinoma?

Answer 14

Endometrial carcinoma

Question 15

What is the difference between a stage IA and IB uterine tumour?

Answer 15

IA = no or <50% myometrial invasion

IB = ≥50% myometrial invasion

Question 16

What is a stage II uterine tumour?

Answer 16

Tumour invades cervical stroma

Question 17

What is a stage III uterine tumour?

Answer 17

Local and/or regional tumour spread:

• IIIA = invading ovary
• IIIB = Invades vagina
• IIIC = pelvic mets and/or para-aortic lymph nodes

Question 18

What is a stage IV uterine tumour?

Answer 18

Tumour invades bladder and/or bowel (IVA) and/or distant mets (IVB)

Question 19

What is the most common reason a uterine cancer patient is unfit for surgery?

Answer 19

High BMI

Question 20

What treatment should you offer in the case of uterine cancer to young women who still desire fertility?

Answer 20

Mirena coil for a year, then remove and they have a year to get pregnant

Question 21

What is lynch syndrome?

Answer 21

A cancer predisposition syndrome that give high risk of colorectal and uterine cancers and an increased risk of ovarian

Question 22

Who is most at risk for leiomyomas/fibroids?

Answer 22

Women >40 and afro-caribbean women

Question 23

What hormone does the growth of leiomyomas/fibroids depend on?

Answer 23

Oestrogen

Question 24

What is the most common diagnostic test for leiomyomas/fibroids?

Answer 24

Ultrasound

Question 25

How is a fibroid seen on USS?

Answer 25

A smooth echogenic mass

Question 26

What is the gold standard treatment for leiomyomas/fibroids?

Answer 26

Hysterectomy - only if family is complete

Question 27

What is the name of the rare malignant tumour of smooth muscle that can occur in the uterus?

Answer 27

Leiomyosarcoma

Question 28

Name some causes of unopposed oestrogen that increases the risk of uterine cancer

Answer 28

HRT, Tamoxifen, | PCOS, nulliparity, infertility

Question 29

What thickness of endometrium in post-menopausal women is suspicious of endometrial cancer

Answer 29

>3mm

Question 30

What is the best treatment for a stage I uterine cancer?

Answer 30

Total abdominal hysterectomy + bilateral salpingo-oophorectomy OR Progesterone for fertility sparing treatment

Question 31

What is the best treatment for a stage II uterine cancer?

Answer 31

Radical hysterectomy + adjuvant | radiotherapy

Question 32

What is the best treatment for a stage III or IVA (nodes) uterine cancer?

Answer 32

``` Radical radiotherapy (external beam and brachytherapy) ```

Question 33

What is the best treatment for a stage IVB (mets) uterine cancer?

Answer 33

Palliative – chemotherapy/ | radiotherapy

Question 34

What is the peak age for cervical cancer?

Answer 34

40-45

Question 35

List some risk factors other than HPV for cervical cancer

Answer 35

 Early age at first pregnancy  Multiparity  Multiple sexual partners  OCP  Smoking  DES exposure  HIV (AIDS defining condition)

Question 36

Apart from EUA, what other technique can be used to obtain a biposy in suspected cervical cancer?

Answer 36

Colposcopy

Question 37

Between what ages is cervical screening done in Scotland?

Answer 37

Between 25 and 64 years

Question 38

What is the best treatment for early stage cervical cancer?

Answer 38

Surgery (radical hysterectomy/ trachelectomy) + Adjuvant radiotherapy if high risk features (+LN, LVI, +ve margins)

Question 39

What is the best treatment for locally advanced cervical cancer?

Answer 39

Chemoradiotherapy

Question 40

What is the best treatment for metastatic cervical cancer?

Answer 40

Palliative chemoradiotherapy