cervical cancer

Question 1

<p>What is the aetiology of cervical cancer?</p>

Answer 1

<ul>
<li>HPV causes 99% of cases</li>
</ul>

Question 2

<p>Describe the epidemiology of cervical cancer (rank, age group, incidence change over time)?</p>

Answer 2

<ul>
<li>10^th most common cancer in woman in Scotland</li>
<li>Peak age 45-55 years</li>
<li>Incidence is decreasing (due to immunisation of HPV and screening)</li>
</ul>

Question 3

<p>What are risk factors for cervical cancer?</p>

Answer 3

<ul>
	<li>HPV infection
	<ul style="list-style-type:circle;">
		<li>Causes 99% of cases</li>
	</ul>
	</li>
	<li>Multiple sexual partners</li>
	<li>Older partner</li>
	<li>Smoking</li>
	<li>Deprived</li>
</ul>

Question 4

<p>What is the presentation of cervical cancer?</p>

Answer 4

<ul>
	<li>Abnormal vaginal bleeding</li>
	<li>Post coital bleeding</li>
	<li>Intermenstrual bleeding/PMB</li>
	<li>Discharge</li>
	<li>Pain – unusual though unless advanced cancer that has spread and is causes neuropathic pain</li>
</ul>

Question 5

<p>How is cervical cancer diagnosed?</p>

Answer 5

<ul>
	<li>Clinical</li>
	<li>Screen detected</li>
	<li>Biopsy</li>
</ul>

Question 6

<p>What investigations are done for cervical cancer?</p>

Answer 6

<ul>
	<li>Biopsy with histology
	<ul style="list-style-type:circle;">
		<li>Majority squamous carcinoma (80%)</li>
		<li>Adenocarcinoma (endocervical)</li>
	</ul>
	</li>
	<li>PET CT, MRI to stage</li>
</ul>

Question 7

<p>What histological type of cancer is most common for cervical cancer?</p>

Answer 7

<ul>
<li><strong>Majority squamous carcinoma (80%)</strong></li>
<li>Adenocarcinoma (endocervical)</li>
</ul>

Question 8

<p>How is cervical cancer staged?</p>

Answer 8

<ul>
<li>Done by PET-CT and MRI</li>
<li>IA
<ul>
<li>Invasive cancer identified only microscopically</li>
<li>IA1 <=3mm depth and <=7mm diameter</li>
<li>IA2 <=5mm depth and >7 diameter</li>
</ul>
</li>
<li>IB
<ul>
<li>Clinical tumours confined to cervix</li>
</ul>
</li>
</ul>

<p>Spread:</p>

<ul>
	<li>Locally (more common than metastases spread)
	<ul style="list-style-type:circle;">
		<li>Stage 2 – vagina (upper 2/3)</li>
		<li>Stage 3 – lower vagina, pelvis</li>
		<li>Stage 4 – bladder, rectum</li>
	</ul>
	</li>
	<li>Metastases
	<ul style="list-style-type:circle;">
		<li>Lymphatic – pelvic nodes</li>
		<li>Blood – liver, lung, bone</li>
	</ul>
	</li>
</ul>

Question 9

<p>Explain the staging of cervical cancer?</p>

Answer 9

<ul>
<li>IA
<ul>
<li>Invasive cancer identified only microscopically</li>
<li>IA1 <=3mm depth and <=7mm diameter</li>
<li>IA2 <=5mm depth and >7 diameter</li>
</ul>
</li>
<li>IB
<ul>
<li>Clinical tumours confined to cervix</li>
</ul>
</li>
</ul>

Question 10

<p>Where does cervical cancer often spread?</p>

Answer 10

<ul>
	<li>Locally (more common than metastases spread)
	<ul style="list-style-type:circle;">
		<li>Stage 2 – vagina (upper 2/3)</li>
		<li>Stage 3 – lower vagina, pelvis</li>
		<li>Stage 4 – bladder, rectum</li>
	</ul>
	</li>
	<li>Metastases
	<ul style="list-style-type:circle;">
		<li>Lymphatic – pelvic nodes</li>
		<li>Blood – liver, lung, bone</li>
	</ul>
	</li>
</ul>

Question 11

<p>What lymph nodes does cervical cancer spread to?</p>

Answer 11

<p>Pelvic nodes</p>

Question 12

<p>Describe the management of cervical cancer?</p>

Answer 12

<ul>
	<li>IA1
	<ul style="list-style-type:circle;">
		<li>Type 3 excision of cervical transformation zone or hysterectomy</li>
	</ul>
	</li>
	<li>IB-IIA
	<ul style="list-style-type:circle;">
		<li>Radical hysterectomy (removal of uterus, cervix, upper vagina, parametria, pelvic nodes, <strong>ovaries are conserved in pre-menopausal woman</strong>) or chemo-radiotherapy</li>
	</ul>
	</li>
	<li>IIB-IV
	<ul style="list-style-type:circle;">
		<li>Chemo-radiotherapy</li>
	</ul>
	</li>
</ul>

Question 13

<p>What improves the prognosis of cervical cancer?</p>

Answer 13

<ul>
<li>Good cure rate if detected early</li>
</ul>