Cervical Cancer

Question 1

Define cervical cancer ?

Answer 1

Is a cancer that is arise from the cervix .

Question 2

What are the main etiology of the cervical cancer ?

Answer 2

Human papillomavirus 16 & 18

Question 3

What are the mechanism of the HPV to help in promoting cancer cell ?

Answer 3

HPV makes viral protien such as E6 and E7 which inhibit the tumor suppressor protien [ p53 ]

Question 4

What are the precancerous cervical changes ?

Answer 4

1. Cervical dysplasia
2. Cervical Intraepithelial neoplasia
3. Adenocarcinoma

Question 5

What is the peak age , site lesion for patient who have cervical cancer ?

Answer 5

PEAK AGE : 60-69 years old

Site lesion : 1. Ectocervical
2. Endocervical

Question 6

What are the risk factor for cervical cancer ?

Answer 6

1. Infections [ HPV ] .
2. Cigarette smoking .
3. Poor Immune System .
4. Long term usage of contraceptive pill .
5. Prior to STD infection .

Question 7

Classification of cervical cancer ?

Answer 7

Gross pathology :

1. Exophytic [ Ectocervix]
2. Ulcerative
3. Infilitrative [ Endocervix & barrel-shapped cervix ]

Histopathology :

1. Squamous cell carcinoma
2. Adenocarcinoma
3. Others [ Clear cell , adenosquamous ]

Question 8

What are the route of the spread ?

Answer 8

Direct :

1. uterus
2. Vagina
3. Parametrium

Lymphatic :

1. Primary Node [ Parametrial , Paracervical ]
2. Secondary Node [ common illiac , paraaortic , Inguinal .

Question 9

What are the general sign and symptoms of cervical cancer ?

Answer 9

1. Referred early if there is abnormal findings in pap smear .
2. Most of the patient are asymptomatic .
3. per vaginal bleeding
4. Abnormal per vaginal discharge .
5. Dysuria
6. Haematuria

Question 10

What are the early and late symptoms of the cervical cancer ?

Answer 10

Early Symptoms :

1. Thin , watery blood tinged vaginal discharge frequently .
2. Abnormal vaginal bleeding [ intermenstrual , postcoital , perimenopausal , postmenopausal ]
3. Blood stained foul vaginal discharge.

Late Symptoms :
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1. Supra pubic pain 
2. leg edema 
3. Urinary & rectal symptoms :
A. Dysuria & Hematuria 
B. Rectal bleeding. 
C. Constipation.

Question 11

What are the findings in physical examination ?

Answer 11

General examination :

1. pallor
2. jaundice
3. Dyspnea
4. palpable inguinal or supraclavicular lymph node.

Abdominal examination :

1. Liver/spleen enlargement .
2. Abdominal mass palpable [ hydronephrosis ].

Vaginal examination :
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CERVIX : 
1. stony hard 
2. ulcerated
3. fixed & contact bleeding 
4. edmatous 
5. irrelgular 
6. enlarged.

Fungating mass
loss of anterior & post.fornix

Rectal examination :

1. bleeding per rectum .
2. palpable mass.
3. parametrium involvement.

Question 12

What are the investigations that we can do it in cervical cancer patient ?

Answer 12

1. Pap smear [ can detect the precancerous condition ]
2. Colposcopy [ identify CIN & Pre-clinical invasive cancer ]
3. Biopsy
4. Lab investigation
5. Imaging

Question 13

what are the general management of the cervical cancer ?

Answer 13

1. Surgery [ A. For microinvasive disease

B. Loop electrosurgical excision procrdure

C. Total hysterectomy

D. Radial hysterectomy

2. Radiotherapy
3. Chemothrapy
4. Chemoradiation.