CPC cervical cancer

Question 1

what does high risk HPV cause

Answer 1

less common cancers
cervix - >99% cases causes by HPV
penis
vulva/vagina 
anus 
mouth 
oropharynx

Question 2

how common is cervical cancer

Answer 2

2500 cases p/a in UK
1200 deaths
10th most common cancer in women in scotland

Question 3

how ‘deadly’ is cervical cancer

Answer 3

good cure rate if detected early

major cause of death in women in low income countries

Question 4

where is the highest uptake of HPV immunisation

Answer 4

higher income countries

Question 5

risk factors for cervical cancer

Answer 5

peak age 45-55yrs
HPV related (16+18) -75% cases
multiple sexual partners
early age at first intercourse
older age of partner
cigarette smoking

most risk factors are related to higher chance of catching HPV infection

Question 6

why is early age at first intercourse a risk factor for cervical cancer

Answer 6

immature cervix

transformation zone is more susceptible to HPV infections

Question 7

epidemiology of cervical cancer

Answer 7

most cases are in younger women
incidence rates peak in younger women and older women

more cases in more deprived areas

Question 8

cervical cancer - red flag symptoms

Answer 8

abnormal vaginal bleeding 
post coital bleeding 
intermenstrual bleeding/PMB
discharge - brown, smell 
pain - advanced cancer, unusual presenting symptom

Question 9

cervical cancer diagnosis

Answer 9

clinical
screen detected - asymptomatic patient is detected through screening
biopsy

Question 10

what is the aim of cervical screening

Answer 10

detect pre-cancerous disease NOT cancer

Question 11

histology of cervical cancer - difference between CIN and cancer

Answer 11

tumour cells from epithelium invade into underlying stroma

Question 12

histology of cervical cancer - types of cancer

Answer 12

majority squamous carcinoma - 80%

adenocarcinoma (endocervical) rising in relative incidence

Question 13

what is seen here

Answer 13

no clear BM - disrupted by invading cancer cells

dark staining dysplastic cells invading into underlying stroma

Question 14

what stage is this (no other symptoms at presentation)

what are the substages within this

Answer 14

stage IA - invasive cancer identified only microscopically

IA1 - ≤3mm depth and ≤7mm diameter (microinvasive)

IA2 - ≤5mm x7mm (increased risk of pelvic LN involvement)

Question 15

what are stage IB tumours

Answer 15

clinical tumours confined to the cervix

Question 16

local spread of cervical cancer

Answer 16

stage 2 - upper 2/3 vagina
stage 3 - lower vagina, pelvis
stage 4 - bladder, rectum

Question 17

spread of cervical cancer - mets

Answer 17

lymphatic - pelvic nodes, more advanced disease can spread via para-aortic nodes
blood - liver, lungs, bone

Question 18

cervical cancer staging

Answer 18

PET-CT

MRI

Question 19

cervical cancer treatment - stages I-II

Answer 19

IA1 - type 3 excision of the cervical TZ or hysterectomy
IB-IIA - radical hysterectomy or chemo-radiotherapy
IIB-1V - chemo-radiotherapy

Question 20

what is a radical hysterectomy

Answer 20

exploration of pelvic and para-aortic space

removal of: uterus, cervix, upper vagina; parametria; pelvic nodes

ovaries conserved in pre-menopausal women

Question 21

what type of RT is used for cervical cancer

Answer 21

external beam

Question 22

what is the schedule of chemotherapy for cervical cancer

Answer 22

once weekly during radiotherapy

Question 23

what is brachytherapy

Answer 23

follows of chemo-RT

caesium insertion to site of tumour for 24hrs