Cervical Cancer

Question 1

Cervical cancer

Answer 1

Cancer of cervical epithelial cells

Squamous cell carcinoma (80%)
Adenocarcinoma (20%)
Most common during reproductive years (20-40)

Question 2

Aetiology of cervical cancer

Answer 2

Sexually transmitted infection:
- HPV 16, 18 (& 33)

Question 3

Pathophysiology of cervical cancer

Answer 3

1. HPV infection of transformation zone
2. E6 and E7 proteins from HPV -> inhibit p53 & pRb (tumour suppressor genes)
3. uncontrolled cell proliferation

Question 4

Risk factors for cervical cancer

Answer 4

Increased risk of HPV:
- early sexual activity
- increased no. sexual partners
- not using condoms

Other:
- not engaging with screening
- high parity
- smoking
- HIV
- COCP (> 5 years)
- family history

Question 5

Clinical features of cervical cancer

Answer 5

• asymptomatic
• abnormal vaginal bleeding
• abnormal (?foul smelling) vaginal discharge
• pelvic pain
• dyspareunia

Question 6

Differentials for cervical cancer

Answer 6

• cervical dysplasia (pre cancerous changes)
• endometrial polyps
• pelvic inflammatory disease

Question 7

Cervical intraepithelial neoplasia

Answer 7

Pre-malignant changes of cervical epithelium
Identified at colposcopy

Question 8

Cervical dysplasia vs. dyskaryosis

Answer 8

Dysplasia:
- neoplasia (pre-malignant changes) on colposcopy

Dyskaryosis:
- abnormal cells on smear test

Question 9

Cervical screening programme

Answer 9

Smear tests:
- aged 25-49 = every 3 years
- aged 50-64 = every 5 years

Question 10

HPV first system

Answer 10

• Testing smear sample for high risk HPV (16,18,33)
• only if returns positive, investigate further e.g. cytology

Question 11

Smear test hrHOV -ve

Answer 11

Return to normal screening recall

Question 12

Smear test hrHPV +ve

Answer 12

Sample to be examined cytologically
normal cytology?
abnormal cytology?

Question 13

Smear test hrHPV +ve with normal cytology

Answer 13

Repeat HPV test at 12 months
(if remains positive at 12 months, repeat at 24 months)

Question 14

Smear test hrHPC +ve with abnormal cytology

Answer 14

Refer for colposcopy

Question 15

Smear test hrHPV +ve at 12 months

Answer 15

Retest at 24 months

Question 16

Smear test hrHPV +ve at 24 months

Answer 16

Refer for colposcopy

Question 17

Smear test hrHPV -ve at 12 or 24 months

Answer 17

return to normal recall

Question 18

Smear test inadequate

Answer 18

Repeat within 3 months

Question 19

Two consecutive inadequate smear samples

Answer 19

refer colposcopy

Question 20

Colposcopy

Answer 20

• speculum + colposcope to magnify cervix
• can also take biopsy - punch or large loop excision

Question 22

Cervical biopsy

Answer 22

• To test for cervical cancer
• Complete during colposcopy
• Punch biopsy or large loop excision
• Take from transformation zone

Question 23

Staging cervical cancer

Answer 23

FIGO staging
I - confined to cervix
II - uterus & upper 2/3 vagina
III - pelvic wall & lower 1/3 vagina
IV - bladder, rectum, or beyond pelvis

Question 23

FIGO staging

Answer 23

Cervical cancer
stage 1-4

Question 24

Managing cervical cancer

Answer 24

Management determined by FIGO stage
Includes:
- large loop excision
- radical hysterectomy & lymph nodes
- chemotherapy
- radiotherapy
- palliative treatment

Question 25

HPV vaccine

Answer 25

• Given prior to becoming sexually active
• protects against HPV 6 & 8 (genital warts) and 16 & 18 (cervical cancer)