Cervical Cancer

Question 1

incidence of cervical cancer

Answer 1

2500 cases per year in UK
1200 deaths
10th commonest cancer in women in Scotland
Good cure rate if detected early
BUT major cause of death in in women in low income countries

Question 2

what are risk factors for cervical cancer

Answer 2

Peak age 45-55 years
HPV related (16 & 18)
Multiple sexual partners
Early age at first intercourse
Older age of partner
Cigarette smoking

Question 3

40 year old P3 attends GP with heavy irregular periods.

GP notices she has not had a cervical screening test since 2005
She says she does not have post coital bleeding
She does not have a regular partner and because of the bleeding she does not have sex
She smokes 25/day

what should her gp do next

Answer 3

Refer as urgent suspected cancer to Gynaecology?

Question 4

what are symptoms of cervical cancer

Answer 4

Abnormal vaginal bleeding
Post coital bleeding
Intermenstrual bleeding/PMB
Discharge
(Pain)

Question 5

how is cervical cancer diagnosed

Answer 5

Clinical
Screen detected
Biopsy

Remember screening aims to detect pre-cancerous disease NOT cancer

Question 6

what is the histology of cervical cancer

Answer 6

Tumour cells from epithelium invade into underlying stroma

Majority squamous carcinoma (80%)

Adenocarcinoma (endocervical) rising in relative incidence

Question 7

how is stage 1a cancer defined

Answer 7

Invasive cancer identified only microscopically.
IA1 ≤ 3 mm depth and ≤7 mm diam (=microinvasive)
IA2: ≤ 5 mm x7 mm

Question 8

how is stage 1b cancer identified

Answer 8

clinical tumours confined to the cervix

Question 9

how is local spread of cervical cancer staged

Answer 9

stage 2: Vagina (upper 2/3),
Stage 3: lower vagina, pelvis,
Stage 4 bladder, rectum

Question 10

how is cervical cancer metastases staged

Answer 10

Lymphatic – pelvic nodes
Blood – liver, lungs, bone

Question 11

how is staging for cervical cancer done

Answer 11

PET-CT
MRI

Question 12

how is cervical cancer treated

Answer 12

Stage 1a1: Type 3 Excision of the cervical TZ or hysterectomy

Stage 1b - 11a:
Radical hysterectomy or
chemo-radiotherapy

Stage 11b - 1V:
Chemo-Radiotherapy

Question 13

what is a radical hysterectomy

Answer 13

Exploration of pelvic and para-aortic space

Removal of:
Uterus, cervix, upper vagina
Parametria
Pelvic nodes
Ovaries conserved in pre-menopausal women

Question 14

what is the treatment for cervical cancer

Answer 14

Radiotherapy- External Beam

Chemotherapy- once weekly during radiotherapy

Brachytherapy - Caesium Insertion (24 hours)