Cervical cancer

Question 1

What is the natural history of cervical cancer?

Answer 1

1 - Infection with HPV (16 & 18 most common in cervical cancer cases)

2 - HPV becomes incorporated into host cell

3 - HPV persists for between 2-3 years

4 - Cervical Intraepithelial Neoplasia (CIN) develops

5 - Within around 10 years, CIN can then go to develop into cervical cancer

Question 2

How does the UK HPV Immunisation programme work?

Answer 2

All girls between 12-18 are offered the vaccine against HPV 6,11,16,18

Question 3

What is the difference between CIN and Cervical cancer?

Answer 3

CIN - Cells still within the basement membrane

Cervical cancer - Cells have spread into surrounding stroma and can spread around into lymph nodes

Question 4

What is the age of peak prevelance of HPV infection?

Answer 4

15-25 years

Question 5

In what way can the Cervical cancer screening programme prevent cervical cancer?

Answer 5

Primary prevention - HPV detection (will become part of routine cervical screening checks in 2019)

Secondary prevention - Detect viral lesions and CIN

Question 6

What factors can increase a womans risk of developing cervical cancer?

Answer 6

Smoking

Question 7

How is a woman with a positive cervical screening result managed?

Answer 7

• Following a +ve test for changes in the cells of the cervix, the sample will also be tested for high risk HPV (16 & 18) if the cell changes are moderate
• If HPV is also found, the patient will be referred for colposcopy
• If the cervical screening test finds significant cellular changes then the patient will be automatically referred for colposcopy without testing for HPV 16 & 18

Question 8

How often are woman invited for cervical screening in the UK?

Answer 8

25-49 years old - screened every 3 years

50-64 - screened every 5 years

Question 9

Which cervical smear results are sent for cytology?

Answer 9

Those which are HPV +ve

Question 10

From where in the cervix are cells taken for cytological assessment?

Answer 10

Transformation zone

Question 11

What changes does the cervical epithelium undergo in cervical intraepithelial neoplasia and cervical cancer?

Answer 11

• Columnar epithelium changes into squamous epithelium due to increase in stromal fluid
• This means that the squamo-columnar junction moves higher up in the transformation zone

Question 12

What are the risk factors for cervical cancer?

Answer 12

HPV Infection

Smoker

Multiple sexual partners

Prolonged OCP use

Question 13

What investigations are performed to diagnose cervical cancer?

Answer 13

Colposcopy with biopsy

Speculum examination of cervix

Question 14

What are the symptoms of cervical cancer?

Answer 14

Vaginal bleeding

Post-coital bleeding

Vaginal discharge

Intermenstrual bleeding/PMB

Question 15

What are the stages of cervical cancer and their cure rates?

Answer 15

1a - 99%

1b - 85%

2a - 75%

2b - 60%

3b - 33%

4 - 15%

Question 16

How is cervical cancer treated?

Answer 16

1 - Radical hysterectomy (stages 1b-2a)

2 - Radiotherapy and chemotherapy (2b and above)

Question 17

Which virus is most commonly associated with cervical cancer?

Answer 17

HPV 16 & 18

Question 18

What is the pre-cancerous form of cervical cancer?

Answer 18

Cervical Intraepithelial Neoplasia (CIN)

Question 19

The abnormalities of which cells can be detected from cervical smears and what are these abnormalities known as?

Answer 19

Squamous cells

Squamous Intraepithelial lesion

Question 20

The transformation zone in the cervix seperates which 2 types of epithelium?

Answer 20

Squamous

Columnar

Question 21

What is the term used to describe abnormal cells of the cervix?

Answer 21

Dyskaryosis

Question 22

If a cervical screening test revealed a high-grade dyskariosis, what should be the next step?

Answer 22

Colposcopy

Question 23

What type of cancer is cervical cancer?

Answer 23

Squamous cell carcinoma

Question 24

What are the steps taken once a small cell change and a significant cell change has been identified from a cervical screening test?

Answer 24

Small cell change:

• Check for HPV
• If HPV found, refer for colposcopy

Significant cell change:

• Refer for colposcopy without checking for HPV