Cervical Cancer

Question 1

What type of tumour are most cervical cancers?

Answer 1

Squamous cell carcinoma

Question 2

What is the second most common type of cervical cancer?

Answer 2

Adenocarinoma

Question 3

What virus is heavily associated with cervical cancer?

Answer 3

Human papillomavirus

Question 4

What strains of HPV is cervical cancer primarily associated with?

Answer 4

HPV 16, 18 (and 33)

Question 5

How does HPV cause cervical cancer?

Answer 5

HPV produces the E6 and E7 oncogenes
E6 oncogene inhibits the p53 suppressor gene
E7 oncogene inhibits the pRB supppressor gene

Question 6

What are the risk factors for cervical cancer?

Answer 6

HPV types 16, 18 and 33
Smoking
HIV
Early first intercourse
Many sexual partners
High parity
Long term combined contraceptive pill use

Question 7

What is the presentation of cervical cancer?

Answer 7

Abnormal vaginal bleeding
Vaginal discharge
Pelvic pain
Dyspareunia

Question 8

What is the first line investigation of cervical cancer?

Answer 8

Vaginal examination and urgent colposcopy

Question 9

What is colposcopy?

Answer 9

Colposcopy is an imaging technique using a colposcope, where the cervix is magnified which allows the epithelial lining to be examined

Question 10

What other investigations are useful in the diagnosis of cervical cancer?

Answer 10

Biopsy
HPV testing
FBC
CT chest/abdo/pelvis

Question 11

How is epithelial dysplasia graded?

Answer 11

CIN (cervical intraepithelial neoplasia) 1 - mild dysplasia, affecting 1/3 of the thickness of the epithelium
CIN 2 - moderate dysplasia, affecting 2/3 of the thickness of the epithelium
CIN 3 - severe dysplasia - likely to turn into cancer if untreated

Question 12

At what age is cervical screening offered?

Answer 12

25-64

Question 13

How often are women screened for cervical cancer?

Answer 13

Every 3 years for those 25-49
Every 5 years for those 50-64

Question 14

What is dyskaryosis?

Answer 14

Abnormal cervical cells detected on a cervical smear

Question 15

How are cervical smear results interpreted?

Answer 15

HPV negative - return to normal recall
HPV positive and normal cytology - repeat HPV test in 12 months
HPV positive and abnormal cytology - refer for colposcopy

Question 16

What is the treatment of cervical intraepithelial neoplasia to prevent cancer?

Answer 16

LLETX procedure (large loop excision of the transformation zone)

Question 17

What is a LLETZ procedure?

Answer 17

A loop of wire with electrical current removes abnormal cervical tissue. This can be performed under local anaesthetic during colposcopy

Question 18

What is the staging of cervical cancer?

Answer 18

Stage 1 - Confined to the cervix
Stage 2 - Invades the uterus or upper 2/3 of the vagina
Stage 3 - Invades the pelvic wall or lower 1/3 of the vagina
Stage 3 - Invades the bladder, rectum or beyond the pelvis

Question 19

What is the different between stage 1A and 1B cervical cancer?

Answer 19

Stage 1A is only visible by microscopy and is less than 7mm large, whereas stage 1B is clinically visible, or more than 7mm

Question 20

What is the treatment of cervical cancer?

Answer 20

CIN or stage 1A - LLETZ procedure or cone biopsy
Stage 1B- 2A - radical hysterectomy and removal or local lymph nodes
Stage 2B-4A - Chemotherapy and radiotherapy
Stage 4B - combination of chemo, radiotherapy and surgery

Question 21

What is a cone biopsy?

Answer 21

A procedure that involves moving a small, cone shaped piece of the cervix

Question 22

To who and when is the HPV vaccine given to?

Answer 22

The HPV vaccine is given to boys and girls aged 12 and 13 (before they become sexually active)

Question 23

When should a patient be recalled if they have a +ve HPV screen, and is -ve after a 12 month follow up?

Answer 23

Return to normal recall

Question 24

When should a patient be recalled if they have two +HPV screens, but cytology is normal for both?

Answer 24

Recall after 12 months

Question 25

What should be done if a patient have +HPV screen with normal cytology after two follow up 12 month screens?

Answer 25

Refer for colposcopy

Question 26

When should a patient who has had treatment for CIN next have a cervical smear?

Answer 26

6 months after treatment