CERVICAL CANCER

Question 0

Why is Pap smear screening effective?

Answer 0

Effective as majority of cancers are preceded with a premalignant lesion which can be treated.

Question 1

When should you start Pap smears? When stop?

Answer 1

Start at 18 years or 2 years after first sexual intercourse.

Stop at age 69.

Question 2

What if LSIL?

Answer 2

Repeat Pap smear in 12 months.

Except women > 30.
Colp now or repeat Pap smear in 6 months.

Question 3

What it HSIL?

Answer 3

Colp for biopsy and excision of lesion

• LLETZ is preferred
• cervical confiscation for non-squamous types

Question 4

When should you check for HSIL treatment?

Answer 4

Check at 1 year, then 2 years if normal

Question 5

Risk factors for HPV infection?

Answer 5

Exposure through sex
- young age at first inter course
- multiple sex partners
- use of ocp 
High parity
Immunosuppressive 
Smoking

Question 6

Gardasil targets which hpv?

Answer 6

6, 11, 16, 18

Question 7

Symptoms?

Answer 7

Usually asymptomatic
PV bleeding
- abnormal bleeding
- post-coital spottinf

Vaginal discharg: watery becoming brown/red
Bowel/bladder symbolism = stage IV 
LOCAL INVASION 
- lumbrosacral 
- lower extremity oedema 
- neuropathic pain

Question 8

Signs?

Answer 8

Speculum: cervix appears red, raised or ulcerated

PR - external mass or blood

Metastasis

• pelvic examination
• hepatomegaly
• pleural effusion or bronchial obstruction

Question 9

Investigations?

Answer 9

LAB
CBE EUC LFT
Pap smear for HPV infection
Colposcopic biopsy

Radiology 
CT/MRI
- degree of invasion 
- lymph node status 
- mets

Question 10

Prevention

Answer 10

Primary prevention

• vaccination gardasil (quadrivalent)
• 3 doses given over 6 months
• condoms

Secondary prevention
- Pap smears

Question 11

Complications of radiotherapy? Complications of conisation?

Answer 11

Vaginal stenosis -/+ dysparenia
Ovarian failure

Cervical insufficiency -> ptl, recurrent pregnancy loss
Cervical stenosis

Question 12

Side effects of vaccine?

Answer 12

Local: redness swelling pain
General: headache, low grade fever, GI upset

Question 13

Import screening principles?

Answer 13

Major health condition
Should be available treatment 
Available facilities for diagnosis and treatment 
Available test or examination. 
Known natural history 
Agreed policy on who to treat 
Cost effective 
Should be a continuous process 
Latent stage