Cervical Conditions - Cancer, Ectropion

Question 1

Cervical cancer screening
-who is screened, and frequency

Answer 1

HIV positive - yearly
25-49 - 3 yearly
50-64 - 5 yearly
Cannot be offered if 64+

Never been sexually active => can opt out of screening due to very low risk
Pregnancy => delayed until 3 month post partym

Best time - mid cycle

Question 2

Cervical management of results

Answer 2

Negative hrHPV => normal recall

Positive hrHPV => cytology
If cytology abnormal => colposcopy
If cytology normal => repeat at 12months

At 12 months
If cytology normal but hrHPV+ => 12 months
At 24months
If cytology normal but hrHPV+ => colposcopy
If cytology normal and hrHPV- => normal recall

Inadequate sample => repeat in 3months
-2 inadequate samples => colposcopy

Treated for CIN1, 2, 3 => 6 months for TOC

Question 3

Treatment of CIN

Answer 3

Large loop excision of transformation zone

Question 4

HPV
-subtypes to be aware of
-cytology changes

Answer 4

Cancer - 16, 18
Genital warts - 6, 11

Koilocyte formation
-big nucleus
-irregular nuclear membrane contour
-darker stain
-perinuclear halo

Question 5

Cervical ectropion
-pathophysiology
-risk factors
-presentation if not asymptomatic
-management

Answer 5

Stratified squamous meets columnar epithelium of cervical canal
-columnar becomes visible on the ectocervix

Ovulation
Pregnancy
COCP use

Often asymptomatic so found on smear
-vaginal discharge
-post coital bleeding

Ablation if symptoms are distressing

Question 6

Cervical cancer
-types
-risk factors
-presentation
-management

Answer 6

SQUAMOUS most common (80%)
Adeno (20%)

HPV greatest risk factor
Smoking
HIV
Early 1st intercourse, many sexual partners
High parity
Lower SES
COCP use

Abnormal vaginal bleeding - postcoital, intermenstrual, postmenopausal
Vaginal discharge

Management determined by staging and patient wishes to maintain fertility
-maintain fertility and confined to cervix - cone biopsy with negative margins
-RT, chemo, palliation

Question 7

Cervical cancer
-staging and management

Answer 7

FIGO staging + wishes of patients to maintain fertility

1A - cervix + only seen on microscopy + U7mm
-hysterectomy +- LN clearance
-if fertility important - cone biopsy
A1 - U3mm deep
A2 - 3-5mm deep
-node evaluation and clearance needed

1B - cervix + visible + 7mm
B1 - U4cm diameter
-RT (brachy or external beam) + chemo (cisplatin)
B2 - 4cm+ diameter
-radical hysterectomy + pelvic LN dissection

2 - tumour extends beyond cervix but NOT pelvic wall
3 - tumour extends beyond cervix and to pelvic wall
-RT + chemo

4 - tumour extends beyond pelvis, with bladder or rectal involvement
A - bladder or rectum
B - outside pelvis
-RT + chemo

Recurrent disease
1ary surgery => chemo or RT
1ary RT => surgery

Question 8

Complications of cancer treatment
-surgery
-RT

Answer 8

Surgery
-bleeding, damage to surrounding structures
-infection
-anaesthetic risk
Cone biopsy => increased risk of preterm birth
Radical hysterectomy => ureteral fistula

RT
Short term - diarrhoea, vaginal bleeding, radiation burns, pain on peeing, tiredness, weakness
Long term - ovarian failure, fibrosis of bowels/skin/bladder/vagina, lymphoedema