Cervical CA

Question 1

A 30 year old woman is sent by her GP to gynaecological outpatients complaining of postcoital bleeding. She has never had a cervical smear. She is unmarried and has had several different sexual partners.

a. You suspect cervical carcinoma. List 3 clinical signs you would look for on your initial clinical examination. (3)

Answer 1

1. Friable, red, raised area on cervix
2. Blood stained vaginal discharge
3. Pelvic mass
4. Lymphadenopathy

Question 2

b. Colposcopic examination and biopsy are arranged and the histopathology confirms a malignant tumour. List the 2 most common types of malignant tumour of the cervix. (2)

Answer 2

1. SCC
2. Adenocarcinoma

Question 3

c. The most common type of malignant tumour is often preceded by a premalignant condition. Name the 3 stages of this premalignant condition in the order in which they occur. (3)

Answer 3

CIN I, II, III

Question 4

d. What agent is important in causing the above premalignant condition? (1)

Answer 4

HPV (16 and 18 = higher risk; 6 and 11 = lower risk)

Question 5

e. Name 2 ways in which this agent can cause abnormal cell proliferation. (3)

Answer 5

1. Integration of viral DNA into epithelial cell DNA encouraging abnormal proliferation
2. Viral antigens/proteins bind to host cell tumour suppressor genes inactivating them