Cervical cancer

Question 1

Risk factors

Answer 1

Increased number of sexual partners
Not using condoms

Non-engagement with cervical screening

Smoking
HIV
COCP use
Family history of cervical cancer
Increased number of full-term pregnancies

Question 2

Presentation of cervical cancer

Answer 2

Abnormal vaginal bleeding (intermenstrual, post-coital or post-menopausal)

Vaginal discharge
Pelvic pain
Dyspareunia (pain during sex)

Question 3

CIN grading system (cervical intraepithelial neoplasia)

Answer 3

CIN is diagnosed at colposcopy (not with screening programme)

CIN I - mild dysplasia, affecting 1/3 the thickness of the epithelial layer, likely to return to normal without treatment

CIN II - moderate dysplasia affecting 2/3 thickness of the epithelial layer, likely to progress to cancer if untreated

CIN III - severe dysplasia, very likely to progress to cancer

Question 4

If suspect cervical cancer what examinations, investigations?

Answer 4

Speculum examination - if cervix appears abnormal - refer for urgent colposcopy

Swabs (to exclude infective cause of abnormal bleeding)

Question 5

What is colposcopy?

Answer 5

Inserting a speculum and using a colposcope to magnify the cervix

Stains are used:

• Acetic acid - makes abnormal cells appear white
• Iodine - healthy cells will stain a brown colour, abnormal cells will not stain

Punch biopsy or large loop excision of the transformation zone can also be performed during colposcopy?

Question 6

What is the management of CIN and very early cervical cancer?

Answer 6

Cone biopsy

Question 7

Staging for cervical cancer

Answer 7

Stage 1: Confined to the cervix

Stage 2: Invades the uterus or upper 2/3 of the vagina

Stage 3: Invades the pelvic wall or lower 1/3 of the vagina

Stage 4: Invades the bladder, rectum or beyond the pelvis

Question 8

Management for cervical cancer

Answer 8

Stage 1B- 2A - radical hysterectomy and removal of local LNs with chemotherapy and radiotherapy

Stage 2B-4A - chemo and radiotherapy

Stage 4B - Management may involve a combination of surgery, radiotherapy, chemotherapy and palliative care

Question 9

How can cervical cancer be prevented?

Answer 9

Condom use
Smear screening
HPV vaccine

Question 10

Differentials for cervical cancer

Answer 10

Cervical polyp
Cervical ectropion
STI Infection e.g. chlamydia
Endometrial cancer

Question 11

What is cervical ectropion?

Answer 11

Cervical ectropion occurs when the columnar epithelium of the endocervix (the canal of the cervix) has extended out to the ectocervix (the outer area of the cervix).

Cells of the endocervix are more fragile and more likely to bleed with trauma e.g. SI

May be asymptomatic or present with:

• Increased vaginal discharge
• Vaginal bleeding
• Dyspareunia

Associated with higher oestrogen levels - e.g. younger women, pregnancy, COCP

Typically resolve as the patient ages, stops the pill or is no longer pregnant