Cervical Cancer Flashcards
Cervical cancer is cancer that’s found anywhere in the cervix, which is the opening between the vagina and the womb and arise from the transformation of cervical epithelial cells. What is the incidence of cervical cancer?
1 - 1000 cases per 100,000
2 - 100 cases per 100,000
3 - 10 cases per 100,000
4 - 1 cases per 100,000
3 - 10 cases per 100,000
3rd most common cause of death in women worldwide
High death rate due to poor screening
Cervical cancer is cancer that’s found anywhere in the cervix, which is the opening between the vagina and the womb and arise from the transformation of cervical epithelial cells. What age does the incidence of cervical cancer peak at?
1 - 20-30
2 - 30-40
3 - 40-50
4 - 50-60
2 - 30-40
Which of the following is NOT a risk factor for cervical cancer?
1 - Non complaint for cervical smear
2 - HPV infection
3 - Nulliparity
4 - Age
5 - HIV infection
6 - early onset/multiple sexual partners
7- Smoking
8 - Immunosuppression
3 - Nulliparity
Female who has never deliver a baby
All of the following are risk factors for cervical cancer, but which is the largest risk factor?
1 - Non complaint for cervical smear
2 - HPV infection
3 - Age
4 - HIV infection
5 - early onset/multiple sexual partners
6 - Smoking
7 - Immunosuppression
8 - low socioeconomic group
2 - HPV infection
- cervical cancer is preventable with HPV vaccine and cervical screening
At what age is the HPV vaccine offered in the UK?
1 - 3-6 y/o
2 - 11-13 y/o
3 - 16-21 y/o
4 - >25 y/o
2 - 11-13 y/o
Can be offered up to the age of 25
The HPV vaccine is offered to 11-13 y/o boys and girls as it reduces the risk of a variety of other cancers as well as cervical cancer. Which of the following is it NOT associated with reducing?
1 - Oropharyngeal
2 - Anal
3 - Penile
4 - Colon
5 - Cervix
6 - Vaginal
7 - Vulval
4 - Colon
Which of the following human papilloma viruses (HPV) have the highest risk of causing cervical cancer?
1 - 13, 18
2 - 6, 13
3 - 16, 18
4 - 6, 18
3 - 16, 18
What are the 2 main oncogenes (mutated form of a gene involved in normal cell growth) that are involved in suppressing genes involved in monitoring the cell cycle, essentially ensuring tumours do not develop?
1 - E6 and 18
2 - E6 and 7
3 - E7 and 18
4 - E7 and 21
2 - E6 and 7
These are responsible for ensuring normal function of tumour suppressor genes
The 2 main oncogenes (mutated form of a gene involved in normal cell growth) that are involved in suppressing genes involved in monitoring the cell cycle, essentially ensuring tumours do not develop are E6 and E7. What are the 2 oncogenes that they are able to supress?
1 - p53 and rasN
2 - p53 and Rb
3 - Rb and rasN
4 - myc and Rb
2 - p53 and Rb
These are both tumour suppressor genes, BUT if E6 and E7 oncogenes become dyfunctional, these tumour suppressor genes no longer suppress tumours
Does a cervical screening diagnose cancer?
- no
- just identifies the pre-malignant phase only 70% sensitive
- not 100% sensitive
At what age do women begin getting cervical smear tests for screening?
1 - 18 y/o
2 - 25 y/o
3 - 35 y/o
4 - >40 y/o
2 - 25 y/o
How often does cervical screening occur for the following:
- women - 25-49 y/o
- women - 49-64 y/o
1 - every 12 months and 3 years
2 - every 3 and 5 years
3 - every 3 years for both
4 - every 5 years for both
2 - every 3 and 5 years
- women - 25-49 y/o = every 3 years
- women - 49-64 y/o = every 5 years
The findings from a smear test can be scored by cytology, and this falls into 3 categories, what are they?
1 - unsuitable, negative, abnormal
2 - ok, good, bad
3 - inadequate, negative, abnormal
4 - inadequate, positive, negative
3 - inadequate, negative, abnormal
- inadequate (not enough sample, blood interfered etc..)
- negative = no abnormalities
- abnormal = requires further investigation and/or closer monitoring
At what age is the HPV offered to boys and girls?
1 - 2-4 y/o
2 - 5-10 y/o
3 - 11-14 y/o
4 - 15-20 y/o
3 - 11-14 y/o
- 2 does give at 0 and 64 months
The ectocervix is the outer part of the cervix. What is the basic cell type of the ectocervix?
1 - non-keratinising stratified squamous epithelial cells
2 - columnar epithelial cells
3 - transitional epithelial cells
4 - keratising sqaumous epithelial cells
1 - non-keratinising stratified squamous epithelial cells
- resistant to low pH of the vagina
The endocervix is the outer part of the cervix. What is the basic cell type of the endocervix?
1 - non-keratinising stratified squamous epithelial cells
2 - columnar epithelial cells
3 - transitional epithelial cells
4 - keratising sqaumous epithelial cells
2 - columnar epithelial cells
- secrete mucus
The basic cell type of the endocervix is columnar epithelial cells that secrete mucus. What happens to the columnar epithelial cells if they are exposed to the acidic pH of the vagina?
1 - undergo hyperplasia
2 - undergo hypertrophy
3 - undergo metaplasia
4 - undergo dysplasia
3 - undergo metaplasia
Process of a mature cell differentiating into a different type of mature cell
Typically columnar to squamous in endocervix to ectocervix
The basic cell type of the endocervix is columnar epithelial cells that secrete mucus. If the columnar epithelial cells are exposed to the acidic pH of the vagina they undergo metaplasia, which is the change from one cell type to another (columnar to squamous). Alternatively, if a patient is infected with human papillomavirus (HPV), what can happen to the cells of the cervix?
1 - further metaplasia
2 - hyperplasia
3 - dysplasia
4 - hypertrophy
3 - dysplasia
- cells change in a gene mutated manner leading to abnormal cell development
What is the name of the junction where the endocervix and ectocervix meet?
1 - transformation zone
2 - endocervix
3 - ectocervix
4 - squamocolumnar junction
4 - squamocolumnar junction
The junction where the endocervix and ectocervix meet is called the squamocolumnar junction (SCJ). The position of this changes throughout a woman’s life. During childhood, the SCJ will be in its original position, what is the location of the SCJ?
1 - very close to the external OS below the internal OS
2 - located in the ectocervix far away from the external OS
3 - progressively moves closer to the external OS
4 - retracts and moves back into the endocervical canal
1 - very close to the external OS below the internal OS
Metaplasia is the term used to describe when one cell type changes into another, and this occurs when the columnar cells become squamous cells when exposed to the acidic vaginal pH. This causes the the squamocolumnar junction (where endocervical (columnar) and ectocervix (squamous) meet to move throughout a woman’s life. What is the movement of the squamocolumnar junction called?
1 - eversion
2 - inversion
3 - migration
4 - hyperplasia
1 - eversion
What is an ectropion?
1 - pre-cursor for cervical cancer in-situ
2 - term used for cervical polyps
3 - glandular cells from endocervix move to ectocervix
4 - early signs of uterine prolapse
3 - glandular cells from endocervix move to ectocervix
- cervix appears red on speculum and can cause post-coital bleeding
What is the most common site for development of cervical squamous neoplasia?
1 - transformation zone
2 - endocervix
3 - ectocervix
4 - squamocolumnar junction
1 - transformation zone
- space between old and new squamocolumnar junction SCJ
What is dyskaryosis?
1 - change in cervical cells appearance, increase cytoplasmic:nuclear ratio, hyperchromatic
2 - change in cervical cells appearance, increase nuclear:cytoplasmic ratio, hyperchromatic
3 - change in cervical cells appearance, increase in cell size
4 - change in cervical cells appearance, decrease in cell size and nucleus, hyperchromatic
2 - change in cervical cells appearance, increase nuclear:cytoplasmic ratio, hyperchromatic
Essentially nucleus becomes bigger
Characterised by hyperchromatic (darker than usual) nuclei and/or irregular nuclear chromatin
Cervical intraepithelial neoplasia (CIN), also called squamous intraepithelial lesions (SIL) is abnormal growth of cells from the basal epithelial of the cervix that could potentially lead to cervical cancer. CIN I-III is used to determine the level of affected epithelial cells of the cervix and ranges from mild to moderate. Match the levels of cells affected in CIN1, CIN II and CIN III using the labels below:
- changes in basal 1/3 of epithelial layer of cervix
- changes in most or all of the epithelial layer of cervix
- changes in basal 2/3 of epithelial layer of cervix
- CIN I = changes in basal 1/3 of epithelial layer of cervix = Low Grade
- CIN II = changes in basal 2/3 of epithelial layer of cervix = High Grade
- CIN III = changes in most or all of the epithelial layer of cervix = High Grade
What will happen if a patient has the following:
- positive for HPV
- cytology report is borderline dyskaryosis (abnormal appearance of cervical cells)
1 - screened again in 12 months
2 - return to normal screening programme depending on their age
3 - screened again in 6 months
4 - refer for colposcopy
4 - refer for colposcopy
Colposcope providing magnification of cervix and biopsy
All patients who are positive for human papillomavirus (HPV) and have abnormal cytology should be referred for what test?
1 - blood tests to test for HPV
2 - return to normal screening programme depending on their age
3 - screened again in 6 months
4 - colposcopy
4 - colposcopy
Colposcope providing magnification of cervix and biopsy
During a colposcopy a colposcope will be used to provide a magnification view of the cervix. At the same time the doctor can insert a speculum which will allow a further biopsy for analysis. This is assisted using a citric/acetic solution which will then be sprayed onto the cervix. We may see some tissue then become white. Why would the tissue become white?
1 - cancerous/pre-cancerous cells increase citric uptake and appear white
2 - cancerous/pre-cancerous cells do not increase citric uptake and appear darker
3 - used to wash away mucus and give better view of the cells
1 - cancerous/pre-cancerous cells increase citric uptake and appear white
- cancercous cells are are high mitotic cells with high replication and glycogen usage
- citric acid is taken up by cancerous cells causing them to become white
- if cells appear white, this is where the biopsy would be taken from for cytology
During a colposcopy a colposcope will be used to provide a magnification view of the cervix. At the same time the doctor can insert a speculum which will allow a further biopsy for analysis. This is assisted using a citric/acetic solution which will then be sprayed onto the cervix. We may see some tissue then become white. Cancerous/pre-cancerous cells are high mitotic replicating cells and glycogen stores so citric acid is taken up causing them to become white. What is the name given to this?
1 - acid-white
2 - acetowhite
3 - alwhite
4 - citric-white
2 - acetowhite
A 27-year-old nulliparous woman is seen in colposcopy following a smear report of severe dyskaryosis. Colposcopy reveals a transformation zone with large areas of dense acetowhite epithelium consistent with cervical intraepithelial neoplasia III (CIN-III). What is the most appropriate management for this patient?
1 - repeat Smear in 6 months
2 - HPV testing
3 - loop excision of transformation zone
4 - single punch biopsy of TZ
5 - repeat colposcopy in 12 months
3 - loop excision of transformation zone
Which of the following is stage I of the FIGO classification for cervical cancer?
1 - tumour has extended beyond the true pelvis or biopsy-proven involvement of the mucosa of the bladder or rectum to other pelvic organs and/or distant organs
2 - tumour extends to the pelvic wall and/or involves the lower third of the vagina and/or causes hydronephrosis or the kidney not to function:
3 - cervical carcinoma confined to the uterus (disregard extension to corpus):
4 - tumour invades beyond the uterus but not to the pelvic wall or the lower third of the vagina
3 - cervical carcinoma confined to the uterus (disregard extension to corpus):
Which of the following is stage II of the FIGO classification for cervical cancer?
1 - tumour has extended beyond the true pelvis or biopsy-proven involvement of the mucosa of the bladder or rectum to other pelvic organs and/or distant organs
2 - tumour extends to the pelvic wall and/or involves the lower third of the vagina and/or causes hydronephrosis or the kidney not to function:
3 - cervical carcinoma confined to the uterus (disregard extension to corpus):
4 - tumour invades beyond the uterus but not to the pelvic wall or the lower third of the vagina
4 - tumour invades beyond the uterus but not to the pelvic wall or the lower third of the vagina
Which of the following is stage III of the FIGO classification for cervical cancer?
1 - tumour has extended beyond the true pelvis or biopsy-proven involvement of the mucosa of the bladder or rectum to other pelvic organs and/or distant organs
2 - tumour extends to the pelvic wall and/or involves the lower third of the vagina and/or causes hydronephrosis or the kidney not to function
3 - cervical carcinoma confined to the uterus (disregard extension to corpus):
4 - tumour invades beyond the uterus but not to the pelvic wall or the lower third of the vagina
2 - tumour extends to the pelvic wall and/or involves the lower third of the vagina and/or causes hydronephrosis or the kidney not to function
Which of the following is stage IV of the FIGO classification for cervical cancer?
1 - tumour has extended beyond the true pelvis or biopsy-proven involvement of the mucosa of the bladder or rectum to other pelvic organs and/or distant organs
2 - tumour extends to the pelvic wall and/or involves the lower third of the vagina and/or causes hydronephrosis or the kidney not to function
3 - cervical carcinoma confined to the uterus (disregard extension to corpus):
4 - tumour invades beyond the uterus but not to the pelvic wall or the lower third of the vagina
1 - tumour has extended beyond the true pelvis or biopsy-proven involvement of the mucosa of the bladder or rectum to other pelvic organs and/or distant organs
If you contract the human papillomavirus (HPV) the majority of patients becomes infected but the immune system eliminates virus within months. However, if the infection persists this can cause squamous intraepithelial lesions (SIL) also called cervical intraepithelial lesions (CIL). What are SILs a precursor of?
1 - vulvar cancer
2 - endometrial cancer
3 - cervical cancer
4 - ovarian cancer
3 - cervical cancer
Cervical cancer is the 3rd most common cause of deaths in women worldwide. What is the most common type of cervical cancer?
1 - columnar cell carcinoma
2 - squamous cell carcinoma
3 - vaginal cell carcinoma
4 - uterine cell carcinoma
2 - squamous cell carcinoma
- accounts for 75%
- 2nd is adenocarcinoma, which is essentially columnar (glandular) cell carcinoma
A 40 y/o female presents with 2 months of post-coital bleeding and a lump in her left groin for 4 weeks. No smear tests for last 10 years. She smokes and has 4 children.
o/e palpable lymph node in the L groin
Palpable mass at cervix that bleeds on examination. Colposcopy biopsy confirms squamous cell carcinoma with locally advanced disease invading surrounding tissues but also para-aortic nodes and liver metastases. What stage according to the FIGO classification is this patient?
1 - stage I
2 - stage II
3 - stage III
4 - stage IV
4 - stage IV
Specifically stage IVB
