Cervical Cancer

Question 1

What is the main cause of cervical cancer?

Answer 1

Infection with papilloma viruses (70%)

Question 2

How may CIN 1 lesions progress?

Answer 2

CIN 1 lesions may regress, remain unchanged or progress to CIN 2, CIN 3 or cervical cancer

Cervical epithelial neoplasia
2/3 are pre-cancerous
Cancer takes 10 years to develop

HPV

Question 3

Give some facts on cervical cancer

Answer 3

• 2500 cases per year in UK
• 1200 deaths
• 10th commonest cancer in women in Scotland
• Good cure rate if detected early
• BUT major cause of death in women in low income countries

Question 4

What is the peak age for cervical cancer?

Answer 4

45-55

Question 5

What are the factors associated with cervical cancer?

Answer 5

• HPV related (16 & 18)
• Multiple sexual partners
• Early age at first intercourse
• Older age of partner
• Cigarette smoking

Question 6

What are the symptoms of cervical cancer?

Answer 6

• Abnormal vaginal bleeding
• Post coital bleeding
• Intermenstrual bleeding/PMB
• Discharge
• (Pain)

Question 7

How may cervical cancer be diagnosed?

Answer 7

• Clinical
• Screen detected
• Biopsy

Question 8

What is the aim of cervical screening?

Answer 8

Aims to detect pre-cancerous disease NOT cancer

Question 9

Describe the histology in cervical cancer

Answer 9

• Tumour cells from epithelium invade into underlying stroma
• Majority squamous carcinoma (80%)
• Adenocarcinoma (endocervical) rising in relative incidence

Question 10

What is stage 1A of cervical cancer?

Answer 10

•Invasive cancer identified only microscopically

Question 11

What are stages IA1 and IA2?

Answer 11

• IA1 ≤ 3 mm depth and ≤7 mm diam (=microinvasive)

* IA2: ≤ 5 mm x7 mm

Question 12

What is stage 1B of cervical cancer?

Answer 12

Clinical tumours confined to the cervix

Question 13

What are the stages of local spread of cervical cancer?

Answer 13

• Stage 2: Vagina (upper 2/3)
• Stage 3: lower vagina, pelvis
• Stage 4: bladder, rectum

Question 14

Where is cervical cancer likely to lymphatically metastasise?

Answer 14

Pelvic nodes

Question 15

Where is cervical cancer likely to metastasise in the blood?

Answer 15

• Liver
• Lungs
• Bone

Question 16

How can cervical cancer be staged?

Answer 16

• PET-CT

* MRI

Question 17

How is stage IA1 treated?

Answer 17

Type 3 Excision of the cervical TZ or hysterectomy

TZ - transformation zone

Question 18

How are stages IB-IIA treated?

Answer 18

Radical hysterectomy or chemo-radiotherapy

Question 19

How are stages IIB-IV treated?

Answer 19

Chemo-radiotherapy

Question 20

What is a radical hysterectomy?

Answer 20

• Uterus, cervix, upper vagina
• Parametria
• Pelvic nodes
• Ovaries conserved in pre-menopausal women

Question 21

Describe cervical cancer treatment

Answer 21

• Radiotherapy - External Beam
• Chemotherapy - once weekly during radiotherapy
• Brachytherapy - Caesium Insertion (24 hours)

Question 22

Summary

Answer 22

Major cause of female death in developing world
HPV is single most important cause
Screening detects pre-invasive changes which are asymptomatic
Cancer causes abnormal vaginal bleeding
Surgery or combined chemoradiation
Effective cure of early stage disease