Cervical cancer

Question 1

what is the most common cause of cervical cancer?

Answer 1

human papilloma virus

Question 2

what is the purpose of screening for cervical cancer?

Answer 2

detection and treatment of pre-invasive changes which are asymptomatic to prevent cancer

Question 3

what types of HBV virus is responsible for most cervical cancers?

Answer 3

HBV 16 and 17

Question 4

what is a squamous intraepithelial lesion?

Answer 4

a group of abnormal cells detectable on smear

Question 5

what are abnormal cells in the cervix detected by biopsy and histology classified as?

Answer 5

cervical intraepithelial neoplasia

Question 6

what HPV virus causes genital warts?

Answer 6

HPV 6, 11, 42, 44

Question 7

what technique is used for a pap smear test to identify HPV infection?

Answer 7

liquid based cytology

Question 8

if someones cytology shows low grade dyskaryosis what is the next step?

Answer 8

refer to colposcopy

this is used to examine the cervix to identify if there is malignant cells and extent of the cancer

Question 9

when are smear tests carried out?

Answer 9

from 25-64 years

every 5 years

Question 10

what are the treatment options for pre-cancerous cervical cancer?

Answer 10

excision - LLETZ: lazer loop excision of the transformation zone

ablation - thermal or laser ablation

Question 11

when are girls immunised against HPV ?

Answer 11

from the age of 12

Question 12

what HPV vaccine will girls get who were born after 1st sep 1990?
sep 2020?
sep 2014?

Answer 12

after 1990 = bivalent vaccine (HPV 16,18)
2012 = quadrivalent vaccine (HPV 16,18,6,11)
2014 = 2 dose regime

Question 13

how is cytology carried out?

Answer 13

cells are scraped from the transitional zone of the cervix

look for abnormal cells and are able to indicate women with squamous intraepithelial lesions (pre cancerous cells)

Question 14

what is dyskaryosis and from what investigation technique can you identify if there is dyskaryosis present?

Answer 14

abnormal cells that can be viewed by cytology (pap smear)

Question 15

what are kilocytes and what do they indicate?

Answer 15

cells with a wrinkled nucleus and perinuclear halo - multinucleated
indicate HPV infection

Question 16

what cell type found on a smear test indicates a HPV infection?

Answer 16

kilocytes

Question 17

what is the recurrence rates of cervical cancer?

Answer 17

5% in 3-5 years

Question 18

what type of cell lines the endocervix and exocervix?

Answer 18

endocervix = columnar epithelium (glandular)
ectocervix = squamous epithelium

Question 19

what part of the cervix does the HPV vaccine invade and why?

Answer 19

transitional zone because it is unstable due to the transition of cells from squamous to columnar

Question 20

what are the risk factors for cervical cancer?

Answer 20

HPV 
smoking
early age of sexually active (<18 yrs)
multiple sexual partners
HIV
immunosuppression 
age (44-55)

Question 21

what is the presentation of cervical cancer?

Answer 21

majority picked up on screening which are asymptomatic

vaginal bleeding
mucoid/purulent discharge 
post-coital bleeding
dyspareunia 
cervical mass
pelvic/back pain

Question 22

how is cervical cancer diagnosed?

Answer 22

speculum examination
colposcopy
biopsy

Question 23

what are the treatment options for cervical cancer?

Answer 23

stage 1: type 3 excision of cervical transitional zone (conization) or hysterectomy
stage 2: radical hysterectomy or chemo-radiatiotherapy
stage 3: chemo-radiotherapy

Question 24

what is the 5 year survival rates for cervical cancer?

Answer 24

stage 1 - 92%
stage 2 and 3 - 56%
stage 4 - 17%

Question 25

where can metastatic cervical cancer spread to?

Answer 25

lymphatic - pelvic nodes

blood - liver, lung and bone

Question 26

how is cervical cancer screening carried out?

Answer 26

Pap smear - scrape off cervical cells at the transformation zone for cytology. every 5 years 25-64 yrs

if HPV present refer patient for colposcopy

if pre-cancerous cells - LLETZ
if cancer - biopsy and further imaging for staging

Question 27

how does HPV cause cervical intraepithelial neoplasia?

Answer 27

HPV viral DNA integrates into host genome
causes over expression of E6 and E7 proteins
this causes deregulation of the host cell cycle

Question 28

at what part of the cervix is cervical cancer most commonly found?

Answer 28

squamocolumnar junction at the transformation zone