cervical cancer

Question 1

features

Answer 1

detected during screening

abnormal vaginal bleeding
vaginal discharge

Question 2

risk factors

Answer 2

HPV 18 + 16
smoking 
HIV
early first intercourse, many sexual partners
high parity 
COCP

Question 3

mechanism of HPV causing cancer

Answer 3

HPV 16+18 produce oncogenes E6 and E7

E6 inhibits p53 tumour supressor gene
E7 inhibits RB supressor gene

Question 4

stage IA

Answer 4

confined to cervix
microscopic
<7mm wide

Question 5

stage IB

Answer 5

confined to cervix
macroscopic
>7mm wide

Question 6

stage II

Answer 6

extension tumour beyond cervix but not pelvic wall

• upper 2/3 vagina
• parametrium

Question 7

stage III

Answer 7

extension beyond cervix + pelvic wall

• lower 1/3 vagina
• pelvic side wall

Question 8

stage IV

Answer 8

beyond pelvis or involvement bladder/rectum

Question 9

Mx - stage IA

Answer 9

hysterectomy +/- lymph node clearance

if want to maintain fertility - cone biopsy with negative margins

Question 10

Mx - stage IB

Answer 10

B1 (<4cm) - radiotherapy + chemotherapy

B2 (>4cm) - radical hysterectomy + pelvic node dissection

Question 11

most common chemotherapy agent used

Answer 11

cisplatin

Question 12

Mx - stage II and III

Answer 12

radiation with chemotherapy

Question 13

Mx - stage IV

Answer 13

radiation and/or chemo