Cervical intraepithelial neoplasia and cervical cancer

Question 1

What is cervical intraepithelial neoplasi

Answer 1

premalignant cellular atypia withing squamous of cervix (This is BEFORE cervical cancer)
figo stage 0

RF - smoking, multiple sexial partners, early age of 1st sex, HIV
HPV 16, 18-95% of cases

peak 25-49, cancer peaks 45-50

gardasil -hpv 6, 11, 16, 18

Question 2

When should women get their cervical smears

Answer 2

If under 25 - can be invited as a 1 time thing

25-50- every 3 years
50-65- every 5 years
65+ -only if one of last 3 were abnormal

high risk - every year
pregnant -delay intil 3m post partum

Question 3

How do you grade cervical intraepithelial neoplasia? and What are the dysplasic changes?

Answer 3

Changes-
incease nuclear/cytoplasmic ration, nucleur size and density
reduce cytoplasm

CIN grades
CIN 1- low grade- mild dysplasia in lower 1/3
CIN2 - high - moderate in 2/3 of epithelial thickness
CIN3 - high - severe dysplasia extending to UPPER 1/3 epithelium - risk of stage 1a FIGO

Question 4

Signs and smear oucomes of cervical intrapithelial neoplasia

Answer 4

Sx-
PV discharge (offensive or blood)
PCB, IMB, PMB
Dyspareunia (deep)

Smear -
CIN 1- borderline/mild dyskariosis (do HPV test after - if -ve recall
Moderate/Severe (CIN II/III), suspected invasive cancer- urgent colopscopy (2ww)

Inadequate - repeat, if 3x- colopscopy

Question 5

Mx of Cervical intraepithelial neoplasia

Answer 5

CIN 1 - conservative -smear in 12m

Anything more -
Large loop excision of transformational zone (LLETZ)- removal of cells with heated loop under LA
(does increase risk of misscariage)

Cone biopsy - rarer and under GA- only if large area

other - cryotherapy, laser, coagulation, hysterctomy

then follow up afte 6m - smear and HPV

Question 6

What is cervical cancer

Answer 6

cancer of the cervix - 80% squamous (epithelial - from CIN), 20% adenocarcinomas (CGIN)

HPV 16.18 related -6% of female cancers
age 45-50

RF - major is HPV
minor - smoking, early 1st sex, many sex partner

Question 7

Sx and Ix of cervical cancer

Answer 7

PV discharge (offensive or bloody)- PCB, IMB, PMB
Dyspareunia (deep)
Sx of late metastases-(SoB, DIC), FLAWS
(metastase to illiac LN, not paraaortic

Ix -
Cervical screen pathway
MRI> CT (CT better for ovarain, endometrial)
Bloods -FBC, UE, LFT, CLotting. GS

Question 8

Mx of cervical cancer

Answer 8

based on FIGO staging
Stage 1a (CIN 3)- Conservative, LLETZ, cone biopsy)

stage 1a2 to 2a- (early)
fertility sparing - trachelectomy (remove cervic + LN)
tumours <4cm - hysterctomy
Tumours >4c- chemoradiation

Stage IIb to IVa- locally advanced
chemoradiation

Stage IVb (metastatic)
combination chemno, single agent/palliative

(ideal - radiotherapy either external beam or internal + cisplastin based chemo)

SE/complications -
surgeries - bladder dysf, sexual dysf, lymphedema
radiotherapy- Lethargy, skin erythema, infertility, dysuria, frequency, etc