Cervical cancer

Question 1

List the muscles lining lateral wall of the pelvic floor.

Answer 1

Lateral wall:

• Piriformis (external rotation of the hip, arises from the anterior part of sacrum and greater sciatic notch, and attaches to the greater trochanter of the femur)
• Obturator internus (obturator fascia)

Question 2

List the muscles lining the pelvic floor.

Answer 2

Puborectalis muscle (aids in defecation, requires voluntary control to relax the rectum) 
Illiococcygeus muscle (part of levator ani) 
Pubococcygeus muscle (part of levator ani) 
Ischiococcygeus muscle

Question 3

What are the risk factors of cervical cancer?

Answer 3

• Multiple sexual partners
• Older age
• OCP use
• Previous history of STIs
• Early sexual activity <21
• Smoking
• HPV infection 16/18, 31/45, or 6/11
• Immunosuppression

Question 4

Briefly describe the blood supply, nerve supply and lymph node drainage of female reproductive tract (mainly cervical).

Answer 4

Arterial supply is through uterine artery, a branch off the internal iliac artery.
Venous supply is through the uterine venous plexus which drains into the internal iliac vein.
Nervous supply is through the uterovaginal plexus, which is a branch off the inferior hypogastric plexus. It supplies both parasympathetic and sympathetic.
Lymph node supply is through external iliac, sacral internal iliac and superficial inguinal lymph nodes, draining into the para-aortic nodes, into cisterna chyli to thoracic duct.

Question 5

Where do cervical cancers metastasise to?

Answer 5

Locally;

Bladder, rectum, peritoneum, ovaries, uterus, vagina.