Cervical Ca

Question 1

what is cervical Ca? what are the 2 subtypes?

Answer 1

cancer within the cervix

squamous cell carcinoma (more common): of the external part of the cervix

adenocarcinoma (less common): of the internal part of the cervix

Question 2

what RF make you more likely to get cervical Ca?

Answer 2

HPV-related
- multiple sexual partners
- not vaccinated
- early sexual initiation (<18Y)

non-HPV-related
- smoking/tobacco
- high parity
- OCP
- co-infection with other genital infections (herpes etc.)

Question 3

how would someone present with cervical cancer?

Answer 3

they are often asymptomatic!
first sign is often abnormal uterine bleeding ➔ specifically post-coital bleeding

other
- foul-smelling or abnormal vaginal discharge
- dyspareunia (pain with intercourse)
- leg swelling
- pelvic or back pain
- constitutional s/s: weight loss, night sweats, fever, anorexia

s/s of mets
- bowel/bladder: hydronephrosis, difficulty urinating, dysuria, hematuria, constipation
- LN: LAD
- lungs: SOB, pleural effusion
- liver: hepatomegaly
- bone: bone pain, fatigue
- brain: ALoC

Question 4

what is the screening process for cervical Ca?

Answer 4

pap smear every 3 years
>25Y + sexually active
until 70Y

Question 5

what is HPV testing?

Answer 5

not OHIP covered
is an option that may come in the future, self vaginal swab and test to see if there is HPV in the sample

less invasive and more specific, but more expensive

Question 6

what happens if you screen positive on pap smear?

Answer 6

repeat the pap in a year if you get an ASCUS or a low-grade squamous epithelial lesion result

if that result is still positive, get a colposcopy for biopsy for dx

if initial result was positive for a high grade lesion, go straight to colposcopy for biopsy

Question 7

once biopsy confirmed for cervical ca, what other ix would you order?

Answer 7

other imaging to assess for potential mets: CT/MRI/PET/bone scan ➔ based on symptoms and most common mets location
- common locations: LN, bowel, bladder, bones, liver, lungs, brain

bloodwork: CBC, lytes, Cr/U, ALT/ALP, bilirubin, PT/INR, albumin

sentinel lymph node biopsy ➔ helps with disease staging

Question 8

what treatment would you offer?

Answer 8

early stage (1/2): surgical resection
- conization and radical trachelectomy (fertility sparing)
- subtotal hysterectomy or total hysterectomy
+ LN dissection + SLNB if not done yet
- offer adjuvant therapy: immunotherapy and chemorads

later stages (2/3): chemorads +/- surg resection if tumour shrinks (not often bc radiation = fibrosis)

late stage (4): palliative: chemo, rads, immunotherapy

Question 9

what cx are you worried about in cervical cancer

Answer 9

• infertility
• mets
• postradiation vaginitis