Cervical Cancer

Question 1

SCREENING-

Wilson’s Criteria for screening of Cervical Cancer:

Answer 1

1. Important health problem-
   Second most common cancer in S.A for women
   Most common cause for cancer deaths.

2.Known natural history:
Yes, known for cervical ca.

3.Latent Phase-
Long latent phase (LSIL and HSIL)

4. Screening easy to perform, sensitive and specific:
   Pap Smears take 5 minutes to perform.

5.Treatment more effective if started early:
Late diagnosis of cervical ca. = increased mortality

6. There should be a policy on who gets
   Rx:
   All women gets treatment.
7. Dx and treatment cost effective:
   Much cheaper to treat in early stage.
8. Continuous case findings:

Question 2

Who do we screen for cervical cancer and when?

Answer 2

-In South Africa, 3 free Pap smears are provided
At the age of 30
40 and
50

• HIV positive women get annual screening
• Aimed for sexually active women because women who are not sexually active have a negligible risk of getting cervical cancer.

Question 3

Who gets a diagnostic Pap Smear?

Answer 3

-Any women with symptoms
Abnormal bleeding, pain and discharge.

-This is different from screening.

Question 4

Pathogenesis of cervical ca.:

Answer 4

-The cervix is made up of endocervix and ectocervix.
Ectocervix is the epithrlium of the cervix that protudes in the vagina. It is lined by squamous cells.

Endocervix is the inner lining of the endocervical canal, lined by columnar cells.

-During puberty, the cervix lengthens, endocervical canal lengthens.
The columnar cells of the endocervix move outwards and are now exposed to the vagina.
(eversion)

• The columnar cells starts going through metaplasia which is the columnar cells becomes replaced with squamous cells.
• This area becomes known as transformation zone and is at risk of dysplasia, which might result in cervical cancer.

Question 5

What contributes to the risk of dysplasia of the transformation zone?

Answer 5

1. HIV
2. Smoking
3. Large oestrogen window
4. HPV
   - Typically 16 and 18.

Question 6

Name the types of cervical cancer we have?

Answer 6

1. Squamous cell carcinoma (most common in SA)
2. Adenocarcinoma (originating from glandular cells of endocervix)
3. ‘other’ Epithelial tumours

Question 7

FIGO staging of cervical cancer?

Answer 7

4 Stages:

• Stage I
• Cancer strictly confined to cervix
• Stage II
• Cancer extends beyond the cervix.
• Extends to upper vagina

-Not to the pelvic side wall

• Stage III
• The cancer has reached the lower third of the vagina

-the cancer has extended to the pelvic side wall

-All cases with hydronephrosis or non-functioning kidney are included
unless they are due to Other known causes

• Stage IV
• Cancer extended beyond true pelvis

or
-has involved the mucosa of the bladder or rectum (biopsy proven)