W06: Cervical Screening; Cervical Ca

Question 1

Pap smear rationale

Answer 1

pap smear = transition zone: site of precancer changes
* original squamo-columnar junction
* increased oestrogen => exposure of columnar epithelium
* metaplasia dt acidic. environment creating new squamo-columnar junction

= zone between new junction and old

• female and 25-64; 5 yearly smears

Question 2

Outline the natural history of human papillomavirus infection and cervical neoplasia and the role of the cervical screening programme

Answer 2

low risk. = genital waart and low grade CIN = self resolve and transient

high risk = persistent infection, increased risk of developing
=> viral integration into host genome = overexpr. of viral proteins = dysreg of host cell cycle

1º Prevention = HPV Infection Stage
2º Prevention = CIN 1 / CIN 2/3 = Pre-cancer screening and prevention

Question 3

• Describe the management of women with a positive screening result

Answer 3

(+) = triage with cytology assessment for DYSKARYOSIS
? cervical intraepithelial neoplasia

=> THEN colposcopy: identifies punch biopsy site, and limits of lesion

• HPV testing is now carried out rather than previous generic cytology: more sensitive

Question 4

• Describe the risk factors, causes, diagnosis and management of cervical cancer

Answer 4

RF: smoking, familial hx, nil HPV vax.

> CIN2/3 excision of transition zone
ablation: thermal /laser

• residual disease thus f/up.

PET-CT, MRI for STAGING
> 1A: excision of TZ or hysterectomy
> 1b-11a: raadicaal hysterectomy or chemoRT
> 11b-1v: chemoRT

Question 5

• Outline investigation of abnormal vaginal bleeding

Answer 5

potential additional symptoms:
- post-coital bleeding
- intermenstrual. bleeding
- discharge
- pain

• speculum test
• biopsy => histological assessment for invasive cancers
• gynae referral

Question 6

Which viruses are implicatedin human cancers?

Answer 6

HBV, HIV, EBV, HPV

Question 7

Histology of cervical cancers

Answer 7

majority squamous carcinoma at 80%

adenocarcinoma (endocervical) rising in incidence too

Question 8

Cervical Ca spread

Answer 8

IA1 - ≤3mm depth, ≤7mm diam = microinvasive

IA2 - ≤5mm x 7mm

IB: clinical tum confined cervix

LOCAL SPREAD
2: upper 2/3 vagina
3: lower vagina, pelvis
4: bladder, rectum

METS
lymph - pelvic nodes
blood - liver, lungs, bone

Question 9

What is radical hysterectomy

Answer 9

removal of uterus, cervix, and upper vagina
+ parametria, pelvic nodes

ovaries conserved in pre-menopausal women

Question 10

ChemoRT for Cervical Ca

Answer 10

RT - external beam

ChemoT - alongside RT

Braachytherapy - Caesium insertion 24hrs