Cervical Cancer

Question 1

What is cervical cancer

Answer 1

Cancer of the cervical cells

Has twin peak incidence

Second most common female cancer!!!

Incidence decreased since screening introduced

HIgh risk HPV assoc in 95% of cases

Question 2

When are the twin peak ages that cervical cancer present

Answer 2

35-50

65-70

Question 3

What are the high risk HPV’s

Answer 3

16 scc

18 adenocarcinoma

31, 45, 51, 52, 56

Question 4

What are the risk factors for developing cervical cancer

Answer 4

Factors predisposing exposure to HPV

• promiscuity
• unprotected sex
• early sexual encounters
• poor sexual hygiene ( male circumcision)

immunodeficiency 
#AIDS 
#smoking
#immunosuppresion 

Multiparity
Contraceptive use

Question 5

Histological types of cervical cancer

Answer 5

SCC (60-80%)

Adenocarcinoma

Epithelial tumours

Question 6

How does cervical cancer metastasise

Answer 6

Hematogenously
-lung , liver, bone

Lymphatic
Pelvic Ln to paraaortic ln to supraclavicular ln

Question 7

TNMZ STAGING OF CERVICAL CANCER

Answer 7

T: primary tumour
TX: primary tumour can’t be assessed
T0: no primary tumour
TIS: CIS=cervical intraepithelial neoplasia
T1: tumour confined to uterus
T2:cervical carcinoma invades beyond uterus
T3: extends into pelvic wall/ lower vagina/ uterus
T4: extension beyond true pelvis/ bladder/ rectum

Question 8

Types of T1

Answer 8

A1:
A2:
B1:
B2:

Question 9

Types of T2:

Answer 9

A: no parametrial invasion

B: with parametrial invasion

Question 10

Types of T3

Answer 10

A: extends into lower 3rd of vagina

B: extends into pelvic wall causing hydronephrosis and kidney dysfunction

Question 11

Sx of cervical cancer

Answer 11

Early

• Vaginal discharge w/ blood spotting
• metrorhhagia

Late sx

• fatigue & weight loss
• flank pain and hydronephrosis
• pedal oedema and thrombosis of pelvic vein
• pain inside the thigh

Question 12

Diagnosis

Answer 12

Stage 1A: biopsy

Stage 1B:

• Rectovaginal palpating
• cystoscopy
• CT for ln
• MRT for metastasis

Question 13

Rx of CIS

Answer 13

Local surgical rx w/ biopsy or LEEP

Question 14

Rx was of cervical cancer stage 1A ( no LN involved)

Answer 14

Cone biopsy if pt wants to preserve fertility

Simple Hysterectomy reccmended

Question 15

Rx for cervical cancer w/ Lymph vessel involvement  
Stage 1A2,
Stage 1B2
Stage 2A
Early 2B

Answer 15

Lymph Vessel invasions suggests metastasis into PELVIC & PARAAORTIC LN

1) Lymphadenectomy of above LN
2) intraoperative frozen section analyses of respected LN to check for metastasis

Lack of metastasis : radical surgery of WERTHEIM (hysterectomy)

Metastasis: 
no hysterectomy. 
irradiation of primary tumour only via 
#per cut radiation w/ CIS PLATIN chemo 
#brachytherapy w/ lithium in resection margins

Question 16

Rx of cervical cancer stage 2b,3&4

Answer 16

Primary radiotherapy w/ chemo using CISPLATIN as sensitiser

Question 17

Rx of cervical cancer stage 4b ( distant metastasis)

Answer 17

Palliative chemo therapy w/ CISPLATIN only