Cervical cancer

Question 1

Epidemiology

Answer 1

3rd most common cancer worldwide and the 4th biggest cause of cancer death.

Question 2

Aetiology

Answer 2

squamous cell carcinoma and is heavily associated with persistent human papilloma virus (HPV) infection.

Question 3

RFs

Answer 3

HPV 16 and 18 infection (accounts for 70% of cases)
Multiple sexual partners
Smoking
Immunosuppression (e.g. HIV or organ transplants)

Question 4

Features

Answer 4

Think PV symptoms, e.g. discharge
PCB or with urination/defecation
suprapubic pain
PV exam: may feel bulkiness

Question 5

Gold standard is for visualisation + biopsy
1. Staging imaging

Answer 5

urgent colposcopy for visualisation + biopsy
CT chest/abdomen/pelvis

Question 6

Cervical screening
1. ages
2. Timing for 25-49 and 50-64
3. What are you screening for
4. What to do if
a. -ve
b. +ve
c. if outcome of cytology is positive
d. HPV +ve but -ve cytology
5. If dyskariosis

Answer 6

1. 25-64
2. 25-49 - 3 yearly
   >49 - 5 yearly
3. Dyskariotic cells (pre-cancerous) before cancer develops
   4.
   a. Return to normal recall
   b. cytological testing
   c. colposcopy
   d. repeat HPV in 12months and 24 months. If still +ve –> colposcopy
4. LLETZ - large loop excision of transformation zone

Question 7

mX
1. Small cancers and spare fertility
2. No fertility-sparing
3. For invasive, infiltrating and early metastatic cancer a […] can be performed which involves removal of the […], […], […], and sometimes the […] and […] ligaments
4.If metastasised

Answer 7

1. Conisation with free margins OR radical trachelectomy
2. Laparoscopic hysterectomy + lymphadenectomy
3. radical (Wertheim’s) hysterectomy, uterus, primary tumour, pelvic lymph nodes, upper third of the vagina, uterovesical and uterosacral
4. Chemo + radio