70. Cervical cancer.

Question 1

what is the cause of cervical cancer ?

Answer 1

HPV 16 and 18 contribute to 75 percent

HPV 31 and 45 another 10 percent

risk factor:
increase in risk : different sexual partners early onset of sexual activity (most strong risk factors)

smoking

oral contraceptives

High parity

Immunosuppression

History of sexually transmitted infections (e.g., herpes simplex, chlamydia)

Low socioeconomic status

In-utero exposure to diethylstilbestrol (DES) has also been linked to cervical cancerindependently of HPV infection

Question 2

what are the signs and symptoms

Answer 2

early stage of cancer - no signs or symptoms

vaginal bleeding - hypermenorrhea
metrorrhagia
vaginal bleeding after intercourse or pelvic exam

Abnormal vaginal discharge: blood-stained or purulent malodorous discharge

dyspareunia

advanced stage such as metastasis - loss of appetite , weight loss , fatigue , pelvic pain

hydronephrosis - due to compression of ureters

Question 3

what are the cervical cancer subtypes ?

Answer 3

squamous cell carcinoma - the highest incidence

adenocarcinoma

aden-squamous carcinoma

small cell carcinoma

neuroendocrine tumor

Question 4

diagnosis of cervical cancer staged ?

Answer 4

using the FIGO system - which is based on clinical examination rather that surgical findings.

only allows -pap smear
and HPV DNA

conisation

endocervical curettage

speculum and colposcopy punch biopsy

hysteroscopy and tissue biopsy

x ray/ct metstaisi

Question 5

describe the cervical staging

Answer 5

tis - confined to surface epithelial cells - in situ

stage 1 - tumor is confined to the cervix

stage 2 -
a - extending to upper third vagina but not the parametric
2b - tumor extending to the parametric

stage 3 -
3a - involves the lower third of vagina - no extension to pelvic wall
3b - pelvic wall extension or hydronephrosis or non functioning kidney

stage 4a - extended beyond the true pelvis or adjacent organs - involving the mucosa of bladder or rectum

4b- distant metastasis

Question 6

what is the clinical management of cervical cancer

Answer 6

because cervical cancer is radiosensitive radiation used in all stages ,
chemotherapy found to be more effective

tis CIN - local laser ablation or surgical removal
large loop excision of the transformation zone
cryotherapy

stage 1a - hysterectomy or cone biopsy

stage 1a2 , 1b , 2a -
radical hysterectomywith bilateral pelvic lymphadenoectomy.
combined with external beam radiation / brachytherapy

stage 2b , 3 and 4a - cisplatin based chemotherapy with radiation

stage 4b -palliative care
radiation therapy
systemic chemotherapy