Cervical cancer & intraepithelial neoplasia

Question 1

Define cervical cancer & intraepithelial neoplasia.

Answer 1

Cervical cancer is a human papillomavirus-related malignancy of the uterine cervical mucosa.

Question 2

Explain aetiology/risk factors of cervical cancer & intraepithelial neoplasia.

Answer 2

Human papillomavirus (HPV) infection is the most important aetiological factor, with most (99.7%) tumours containing HPV DNA.

HPV-16 and 18 are the most common high-risk types.

Other high-risk types include 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73, and 82.

Common risk factors: aged 45-49, early onset of sexual activity,

Question 3

Summarise the epidemiology of cervical cancer & intraepithelial neoplasia.

Answer 3

Cervical cancer is the fourth most common malignancy in women worldwide.

Question 4

Recognise the presenting symptoms of cervical cancer & intraepithelial neoplasia.

Answer 4

Abnormal vaginal bleeding, postcoital bleeding, dyspareunia, cervical mass

Can present without symptoms and is caught on pap smear

Question 5

Recognise the signs of cervical cancer & intraepithelial neoplasia on physical examination.

Answer 5

Abnormal pap smear results on cytology

CIN I is the least invasive and CIN III is the most severe

Question 6

Identify appropriate investigations for cervical cancer & intraepithelial neoplasia and interpret the results.

Answer 6

Speculum: Cervical mass may be seen, cervical bleeding

Cytology: Look for HPV and then abnormal cells

CIN grading can be done after histology

Question 7

Generate a management plan for cervical cancer & intraepithelial neoplasia.

Answer 7

Low grade can be treated with LLETZ or cone biopsy.

High grade consider radiotherapy and chemothrapy.

Question 8

Identify the possible complications of cervical cancer & intraepithelial neoplasia and its management.

Answer 8

Cone biopsy and LLETZ may result in cervical shortening > cervical incompetence which can lead to preterm labour and fertility issues

Question 9

Summarise the prognosis for patients with cervical cancer & intraepithelial neoplasia.

Answer 9

The 5-year survival varies based on disease stage at diagnosis:

Localised (stage I): 92%

Regional (stage II-III): 56%

Distant (stage IV): 17%.