Cervical Cancer

Question 1

What constitutes the lower 1/3 of the uterine body?

Answer 1

Cervix

Question 2

How many parts does the cervix have?

Answer 2

2 parts

• Endocervix with tall mucus secreting epithelium and
• Ectocervix with non-keratinized stratified squamous epithelium

Question 3

What does CIN stand for?

Answer 3

Cervical intraepithelial neoplasia

Question 4

What is CIN?

Answer 4

The pre-invasive stage of cervical cancer where there is dysplasia, it’s asymptomatic and detectable by cervical screening

Question 5

Where does the squamo-columnar junction present in pregnancy/from puberty onwards?

Answer 5

Vaginal surface of the external os

-This is also the area where squamous metaplasia occurs

Question 6

Precursor of cervical squamous carcinoma?

Answer 6

CIN

Cervical intraepithelial neoplasia

Question 7

What causes genital warts?

Answer 7

Low risk HPV strains 6+ 11

Question 8

What type of cells indicate HPV infection?

Answer 8

Koilocytes

Question 9

What are koilocytes?

Answer 9

Cells with a wrinkled pyknotic nucleus and perinuclear clearing

Question 10

What is pyknosis?

Answer 10

The irreversible condensation of chromatin in the nucleus of a cell

Question 11

Main strains implicated in cervical cancer?

Answer 11

HPV 16 and 18

Question 12

Precursor to adenocarcinoma?

Answer 12

CGIN

Question 13

Most cases of cervical cancer are caused by genetics. True or False?

Answer 13

FALSE

Caused by high risk HPV infection

Question 14

How is HPV transmitted?

Answer 14

Via close skin to skin contact such as genital to genital contact and anal, vaginal and oral sex

Question 15

Can HPV cause other cancers aside from cervical?

Answer 15

Yes.

Vulval, vaginal, anal and oropharyngeal cancers

Question 16

Where do most squamous carcinomas arise?

Answer 16

Squamo-columnar junction

Question 17

Where does squamous carcinoma initially spread to?

Answer 17

Uterine body 
Vagina 
Bladder 
Ureters 
Rectum

Question 18

How does lymphatic spread usually occur in squamous carcinoma?

Answer 18

Can spread early via the external, internal and common iliac nodes as well as aortic nodes

Question 19

When does haematogenous spread occur?

Answer 19

Late in squamous carcinoma

-Spreads to liver, lungs ad bones

Question 20

What is CGIN?

Answer 20

Preinvasive of adenocarcinoma and is more difficult to diagnose on a smear

Cervical glandular intraepithelial neoplasia

Question 21

What percentage of carcinoma is adenocarcinoma? and where does it commonly arise?

Answer 21

10%

-Most arise in endocervical canal

Question 22

What does cervical screening look for?

Answer 22

For CIN before it becomes clear

Question 23

Who should be screened for cervical screening?

Answer 23

Those with a cervix
Every 5 years
Age 25-65

Question 24

Process of cervical screening?

Answer 24

1) Smear is tested for HPV, if negative nothing further is done
2) If positive the cytology is looked at
3) If smear is negative: recall in 5 years

Question 25

Cervical screening:

-HPV +ve, cytology +ve, low grade:

Answer 25

Seen for colposcopy within 8 weeks

Question 26

Cervical screening:

HPV: +ve, +ve cytology, high grade

Answer 26

Seen for colposcopy within 4 weeks

Question 27

Cervical screening:

HPV positive, glandular abnormality or suspicion of invasion?

Answer 27

Seen within 2 weeks

Question 28

What does colposcopy do?

Answer 28

This allows the cervix to be examined in more detail through use of speculum and microscope

-Squamocolumnar junction must be visualized

Question 29

What happens when acetic acid is applied in colposcopy to a cancer?

Answer 29

Epithelium appears white in colour because abnormal epithelium contains more protein and less glycogen than normal epithelium

Question 30

What happens after acetic acid turns epithelium white?

Answer 30

Punch biopsy

- To identify CIN

Question 31

Treatment of CIN-1?

Answer 31

Conservative management for 2 years

Question 32

Treatment of CIN 2 or 3?

Answer 32

Excision or ablation

Question 33

Presentation of cervical cancer?

Answer 33

• Often asymptomatic in early stages
• Post coital bleeding
• Foul smelling discharge which in thin, watery and sometimes blood stained
• Intermenstrual bleeding
• Pelvic pain
• Menorrhagia

Advanced disease;
-Backache, leg pain, haematuria, wt loss, anaemia, changes in bowel habit

Question 34

Investigations of cervical cancer?

Answer 34

• Colposcopy
• Biopsy of tumour
• MRI and PET for assessment of spread

Question 35

Management of cervical cancer?

Answer 35

• Local excision can be done for 1A lesions
• Hysterectomy can be done with stage IB-IIB and may also offer radiotherapy (stage II involvement of adjacent organs)
• Stage IIB-IV is usually treated with chemoradiation and platinum based chemo (III has involvement of pelvic wall and IV has distant mets or bladder/rectum involvement)
• Most recurrences of cervical cancers are only suitable for palliative acre

Question 36

What does stage II mean?

Answer 36

Involvement of adjacent organs

Question 37

Stage III means?

Answer 37

Involvement of pelvic wall

Question 38

Stage IV?

Answer 38

Distant mets or bladder/rectum involvement

Question 39

HPV vaccination is given to who?

Answer 39

Boys and girls

Age 12-13 as 2 doses 6 months apart

Question 40

What is the current vaccine?

Answer 40

Quadrivalent for types 16, 18, 6 and 11 (2 high risk types and 2 types which cause genital warts)

Question 41

How muc protection does HOV vaccination offer?

Answer 41

70% protection against cervical cancer