4 - Gynae - The Cervix and its disorders - Carcinoma of the Cervix

Question 1

what are the two peak ages? when are most cases? incidence is falling, why?

Answer 1

30 + 80
25-49
due to screening

Question 2

pathology - 90% are ? 10% are? from ? epithelium. 2 points about 10% type?

Answer 2

SCC
adenocas from columnar
worse prog and increasing relative to SCCs

Question 3

aetiology - virus? trans? causes what? how to prevent? what incr risk? what about a FHx?

Answer 3

HPV
sex
CIN
vaccine HPV 16 + 18 to all girls pre sexually 
smoking, COCP, immunosuppression

not familial

Question 4

Clinical features:

• occult? diagnosis by?
• clinical ca - 4 parts of a classic Hx? what about Ex?

Answer 4

occult - aSx diagnosis by biopsy/LLETZ
clinical Ca - smears missed, PCB, offensive discharge, IMB/PMB common
ulcer/mass may be visible/palpable on cervix

Question 5

Clinical features - what happens in later disease? to cause what?

Answer 5

invasion of ureters, bladder, rectum, and nerves > uraemia, haematuria, rectal bleeding + PAIN

Question 6

staging - describe 4 stages

Answer 6

1 cervix and uterus (ai <3mm depth, <7mm across) (aii) <5m depth, <7mm across) (1b - the rest)
2 upper vagina also (a not parametrium, b in parametrium)
3 lower vagina or pelvic wall, or ureteric obstruction
4 into bladder or rectum, or beyond pelvis

Question 7

Ix - biopsy to ? what used to assess size and invasion to stage disease? what used to show bladder invasion and what used to show size/spread and LN inv? what to assess pt fitness for trt? also??

Answer 7

confirm diagnosis
VE and DRE under anaesthesia unless clearly small
bladder - cystoscopy 
MRI for size/spread/LNs
FBC, U+E, CXR
cross match

Question 8

Prognosis depends on ? ? + ?

overall 5y survival? patient reviewed how often?

Answer 8

LN inv, clinical stage and histo grading

65%

3 nd 6m then every 6m for 5y

Question 9

TRT

• 1ai?
• 1aii-1bi?

Answer 9

• cone biopsy or simple hysterectomy

- lapscop lymphadenectomy (to confirm -ve LNs) and radical trachelectomy to preserve fertility

Question 10

TRT

• 1aii-2a
• 2b-4

Answer 10

LNs neg? - wertheim’s hysterectomy or CTx/RTx
LNs pos? - CTx/RTx with no surgery

CTx/RTx with no surgery

Question 11

poor prog indicators? death how?

Answer 11

death - uraemia due to ureteric obstruction

LNs +ve
advanced stage
large 1’ tumour
poorly diff tumour and early recurrence