Cervical cancer

Question 1

Cervical cancer typically affect women of what age?

Answer 1

Younger women, peaking in the reproductive years

Question 2

1) What is the commonest histiologucal subtype of cervical cancer?
2) What is the second commonest subtype?

Answer 2

1) Squamous cell carcinoma
2) Adenocarcinoma

Question 3

1) What is the commonest cause of cervical cancer?
2) Name 2 other cancers that this cause is associated with?
3) What are the 2 important strains of this cause?
4) This cause produces two proteins (E6 and E7) that inhibit tumour suppressor genes - which tumour suppressor gene does E6 and E7 inhibit?

Answer 3

1) Human-papillomavirus
2) Anal, vulval, vaginal, penis, mouth and throat cancers
3) 16 and 18
4) E6 = p53 and E7 = pRb

Question 4

Name 4 risk factors for developing cervical cancer

Answer 4

• Increased risk of getting HPV (Early sexual activity, increased number of sexual partners, sexual partners who have had more partners, not using condoms)
• Not engaging with screening
• Smoking
• HIV
• Family history
• Exposure to diethylstilbestrol during fetal development
• Combined contraceptive pill use for more than five years

Question 5

Name 2 presenting symptoms that should make you consider cervical cancer as a differential

Answer 5

• Abnormal vaginal bleeding (intermenstrual, postcoital or post-menopausal bleeding)
• Vaginal discharge
• Pelvic pain
• Dyspareunia

Question 6

1) Cervical cancer symptoms are non-specific, and in most cases, not caused by cervical cancer. The next step is to examine the cervix with a speculum - name 2 changes that may imply cervical cancer
2) Where there is an abnormal appearance of the cervix suggestive of cancer, an urgent cancer referral for what is done?

Answer 6

1) Bleeding, visible tumour, ulceration, inflammation
2) Colposcopy

Question 7

Cervical intraepithelial neoplasia is a grading system for the level of dysplasia in the cells of the cervix - from what investigation is CIN diagnosed?

Answer 7

Colposcopy

Question 8

Screening for cervical cancer involves a cervical smear test - what are pre-cancerous changes in cervical smears called?

Answer 8

Dyskaryosis

Question 9

What is the current cervical screening program?

Answer 9

Every three years aged 25 – 49 and every five years aged 50 – 64

Question 10

A cone biopsy is a treatment for cervical intraepithelial neoplasia and very early-stage cervical cancer - what does it involve?

Answer 10

A surgeon removes a cone-shaped piece of the cervix using a scalpel and the sample is sent for histology to assess for malignancy

Question 11

1) When is the HPV vaccine ideally given to girls and boys?
2) The current NHS vaccine is Gardasil, which protects against which 4 strains of HPV?
3) Which 2 strains protect against cervical cancer, and which protect against genital warts?

Answer 11

1) Before they become sexually active
2) 6, 11, 16, 18
3) 6 and 11 = warts, 16 and 18 = cancer

Question 12

1) What are the 2 treatment options for cervical intraepithelial neoplasia and early-stage (1A) cervical cancer?
2) What is the treatment for stage 1B-2A?
3) What is the treatment for stage 2B-4A?
4) What is the treatment for stage 4B?

Answer 12

1) Cone biopsy or Large Loop Excision of the Transformation Zone (LLETZ)
2) Radical hysterectomy and removal of local lymph nodes with chemotherapy and radiotherapy
3) Chemotherapy and radiotherapy
4) Combination of chemotherapy, radiotherapy, surgery and palliative care

Question 13

A monoclonal antibody that targets vascular endothelial growth factor A (VEGF-A) may be used in combination with other chemotherapies in the treatment of metastatic or recurrent cervical cancer - what is it called, and how does it work?

Answer 13

Bevacizumab. VEGF-A is responsible for the development of new blood vessels, therefore bevacizumab reduces the development of new blood vessels