Cervical Ca

Question 1

What makes up LSIL

Answer 1

Flat condylomas 
Cin 1 (mild dysplasia)

Question 2

What makes up HSIL

Answer 2

Cin 2

CIN 3

Question 3

Most common histological subtype of cervical ca

Answer 3

These are squamous cell carcinoma- linked to hpv

Question 4

What is the commonest cause of death in Cervical cancer

Answer 4

Ureteric invasion-> stasis of urine-> Hydronephrosis-> pyelonephrosis-> uraemia-> death

Question 5

Clinical features of cervical cancer

Answer 5

Post coital bleeding
Intermenstrual bleeding
Post menopausal bleeding

Vaginal discharge - brown/red and foul smelling

Question 6

Approach to CIN 1(lsil)

Answer 6

Observe with regular cytology every 6 months
Repeat Pap smear in 6 months

Colposcopy if 2nd time still positive

Question 7

Approach to cin 2&3 hsil

Answer 7

Colposcopy referral

Lletz, come excision,

Hysterectomy if no desire for children

Question 8

Approach to stage 1a1 and describe what is stage 1a1

Answer 8

Microinvasive(less than 3mm invasion and confined to cervix

If fertility desired: trachelectomy(removal of the cervix) lesion must be less than 2cm for this to be done
Conization

Simple hysterectomy if fertility not desired

Pap smears continued as risk of VIN5%

Question 9

Approach to 1a2 and 1b1 and what are they

Answer 9

1a2- greater than 3mm deep and confined to cervix
1b1- widest demensuon less than 4 cm and confined to cervix

Radical hysterectomy and pelvic lymphadenectomy- wertheim operation - uterus, cervix, upper third of vagina, parametrium and nodes removed

Or
Primary radiation therapy- ovaries can be spared

May do radical trachelectomy- cervix and parametria