Cervical screening and cancer

Question 1

Where is HPV infection and CIN seen in screening?

Answer 1

Transformation zone of cervix

Question 2

Who is the peak incidence of HPV in?

Answer 2

15-25 year olds

Question 3

What % of cervical cancers are associated with HPV?

Answer 3

> 99%

Question 4

What % anal cancers are associated with HPV?

Answer 4

90%

Question 5

What is the progression of HPV causing changes?

Answer 5

Early infection may be accompanied by mild changes in the epithelium
Abnormal growth of squamous cells detectable on smear- squamous intraepithelial lesion
Abnormal cells in cervix detected by biopsy and histological examination- classified as CIN

Question 6

What HPV is highest risk for developing cancer?

Answer 6

16

Question 7

What does th HPV vaccine vaccinate against?

Answer 7

6, 12, 16, 18

Question 8

Who is cervical screening given to?

Answer 8

25-49 year olds every 3 years

50-64 every 5 years

Question 9

What is the cervixal smear looking for?

Answer 9

High risk HPV DNA or RNA

Question 10

How is the HPV test done?

Answer 10

Hybridisation

PCR

Question 11

When is cervical cytology done?

Answer 11

If HPV +

Question 12

What is cervical cytology?

Answer 12

Microscopic assessment of cells scraped from transformation zone

Question 13

What does cervical cytology look for?

Answer 13

Abnormal cells- dyskaryosis

Question 14

What causes CIN?`

Answer 14

Persistent HPV infection

Question 15

What are the grades of CIN?

Answer 15

1- low grade, will regress
2- moderate dysplasia, may regress
3- severe dysplasia, unlikely to regress, precursor to cancer

Question 16

What is the treatment of CIN?

Answer 16

LLETZ (excision)
Thermal coagulation
Laser ablation

Question 17

What is the followup of CIN treatment?

Answer 17

Confirm treatment effective
Prevent invasive cancer and monitor for further cancer
Reassure woman

Question 18

What are the majority of cervical cancers?

Answer 18

Squamous carcinomas

SOme adenocarcinomas

Question 19

What is the staging of carvical cancer?

Answer 19

1- a- <5mm depth by <7mm diameter 
b- Confined to cervix
2- spread to vagina
3- lower vagina, pelvis
4- bladder, retum

Question 20

Where does lymphatic spread of cervical cancer go?

Answer 20

Pelvic nodes

Question 21

Where does cervical cancer metastasise?

Answer 21

Liver
Lungs
Bone

Question 22

Who age is cervical cancer mostly seen in?

Answer 22

45-55

Question 23

What HPV infections cause cervical cancer?

Answer 23

16 and 18

Question 24

What are the risk factors for cervical cancer?

Answer 24

Multiple partners
Early age at first intercourse
Older age of partner
Cigarette smoking

Question 25

What are the signs and symptoms of cervocal cancer?

Answer 25

Abnormal bleeding
Post coital bleeding
Intermenstrual/post menopausal bleeding
Discharge
Rarely pain

Question 26

What is the treatment of cervical cancer?

Answer 26

Excision
Hysterectomy
Radial hysterectomy
Chemo-radiotherapy

Question 27

What is removed in a radical hysterectomy?

Answer 27

Uterus, cervix, upper vagina
Parametria
Pelvic nodes