Cervical cancer

Question 1

80% of cervical cancers are

Answer 1

squamous cell carcinomas

Question 2

What is the second most common type of cervical cancer

Answer 2

adenocarcinoma

Question 3

Which types of HPV are most associated with cervical cancer

Answer 3

16 & 18

Question 4

How does HPV cause cervical cancer

Answer 4

Produce proteins E6&7 that inhibit tumour suppressor genes p53 and pRb

Question 5

Increased risk of catching HPV occurs with

Answer 5

early sexual activity
increased number of sexual partners
not using condoms

Question 6

Other than HPV what are some risk factors for cervical cancer (5)

Answer 6

Smoking
HIV
COCP use for >5 years
increased number of full term pregnancies

Question 7

presenting symptoms that should make you consider cervical cancer (4)

Answer 7

abnormal vaginal bleeding
vaginal discharge
pelvic pain
dyspareunia

Question 8

Appearances on speculum exam that can suggest cervical cancer (4)

Answer 8

Ulceration
Inflammation
bleeding
visible tumour

Question 9

dysplasia in the cervix is called

Answer 9

cervical intraepithelial neoplasia

Question 10

define CIN 1

Answer 10

mild dysplasia
affecting 1/3 the thickness of the epithelial layer
likely to return to normal without treatment

Question 11

define CIN 2

Answer 11

moderate dysplasia
affecting 2/3 the thickness of the epithelial layer
likely to progress to cancer if untreated

Question 12

define CIN 3

Answer 12

severe dysplasia
very likely to progress to cancer if untreated

Question 13

CIN III is sometimes called

Answer 13

cervical carcinoma in situ

Question 14

What is dyskaryosis in the context of cervical malignancy

Answer 14

cells are examined under a microscope for precancerous changes

Question 15

When is dyskaryosis performed for cervical malignancy

Answer 15

If high risk HPV is detected

Question 16

When aged 25-49 cervical smears are performed

Answer 16

every 3 years

Question 17

When aged 50-64 cervical smears are carried out

Answer 17

every 5 years

Question 18

Women with HIV should have a smear

Answer 18

annually

Question 19

pregnant women due a smear should

Answer 19

wait until 12 weeks post partum

Question 20

Actinomyces-like organisms are often discovered at the smears of women who

Answer 20

have IUD’s

Question 21

What should be done if a patient’s smear results show an inadequate sample

Answer 21

repeat after at least 3 months

Question 22

What should be done if a patient’s smear results show that they are HPV negative

Answer 22

continue routine screening

Question 23

What should be done if a patient’s smear results show normal cytology but HPV negative

Answer 23

repeat after 12 months

Question 24

What should be done if a patient’s smear results show abnormal cytology and HPV positive

Answer 24

refer for colposcopy

Question 25

During colposcopy what can be used to differentiate abnormal areas

Answer 25

acetic acid; iodine solution

Question 26

When using acetic acid in colposcopy abnormal areas

Answer 26

appear white indicating increased nuclear to cytoplasmic ratio

Question 27

When using iodine in colposcopy abnormal areas

Answer 27

will not stain

Question 28

What should a woman be warned of after a large loos excision of the transformation zone on colposcopy

Answer 28

not to use a tampon after procedure
increased risk of preterm labour

Question 29

treatment for CIN

Answer 29

cone biopsy
LLETZ

Question 30

risk of a cone biopsy (5)

Answer 30

pain
bleeding
infection
scar formation with stenosis of the cervix
increased risk of miscarriage and premature labour

Question 31

FIGO stage 1 cervical cancer

Answer 31

confined to cervix

Question 32

FIGO stage 2 cervical cancer

Answer 32

Invades the uterus or upper 2/3 of the vagina

Question 33

FIGO stage 3 cervical cancer

Answer 33

Invades the pelvic wall or lower 1/3 of the vagina

Question 34

FIGO stage 4 cervical cancer

Answer 34

Invades the bladder, rectum or beyond the pelvis

Question 35

monoclonal antibody that may be used with other chemotherapies in the treatment of metastatic or recurrent cervical cancer

Answer 35

Bevacizumab (avastin)