Cervical Carcinomas

Question 1

A little about cervical cancer

Answer 1

Aim to detect pre-invasive stage-1900 die in UK annually
Main cause- HPV
Vaccine only covers HPV 16+18-70% of cases.
99.7% contain HPV DNA,
Prolonged pill may ⬆️ riskx4
RFs- high parity, many (>4 sexual partners) or partner with many other partners esp if male uncircumcised.
Smoking,
Other STDs
Early first coitus

Question 2

How do you manage abnormal smears?

Answer 2

Histology–> colposcopy, and biopsy depending on likelihood of CErvical intra-epithelial neoplasia (CIN) III, Or small volume invasive disease (

Question 3

How would youn treat pre-invasive cancer?

Answer 3

Examine cervix by colposcope
Abnormal epithelium: characteristic blood vessel patterns&stains white with acetic acid.
Punch biopsies
CIN destroyed by cryotherapy, laser, cold coagulation or large loop excision of transformation zone (LLETZ)
90% cure rates, once
Annual smears for at least 10 years
Abnormal tissue found on histology- removed in cone biopsy
Colposcopy does not detect adenocarcinoma (lies in endocervical canal)

Question 4

How is the invasive disease classified?

Answer 4

Most: squamous, 15-30% adenocarcenomas( endocervical epithelium, women under 40)
Spread is local + lymphatic.
Stage I- tumours confound to cervix.
II- extended locally to upper 2/3 of vagina. IIb) if to parametria
III- spread to lower 1/3 of vagina. IIIb) or to pelvic wall
IV- spread ro rectum and bladder. IV) spread to distant organs.

Most oresent at stage I+II

Question 5

How do u diagnose cervical cancer?

Answer 5

Non-menstrual bleed is the most common.
Firm, grows and bleeds on contact.
CT/MRI to stage
PET scan if unsuitable for surgery to alter regimnes- detects para-aortic metastases.

Question 6

How do you treat an invasive cancer?

Answer 6

Stage I- microscopic lesions,

Question 7

What is the main chemo agent?

Answer 7

Cisplatin + topotecan for reccurent/ metastatic, increases survival
+ ⬆️ toxicity.

Question 8

Whatbare the cure rates for stages ?

Answer 8

I - 80% 5Y survival
II-60%
Radiotherapy causes vaginal stenosis- intercourse + lubricant should encouraged within 2 months.
Follow-up- annual smears.

Question 9

Can u do a smear after radiotherapy?

Answer 9

No, cz that superficial epithelium is now destroeyd.

Question 10

What are some terminal problems?

Answer 10

Pain,
Fistulas,
GI/GU obstruction