Gyn CIN and cervical cancer

Question 1

How to act on CIN diagnosis

Answer 1

after screening–
CIN1 is likely to resolve on its own-repeat smear in 12 months
CIN2,3, and CGIN - recomend removal - via LLETZ or cone biopsy

LLETZ-outpatient, local-
remove abnormal cells, can be done during colopscopy, day case
care-increase risk of midtrimester misscarrige

Cone biosy- large excision- under general anesthesia
high risk of midtrimester loss and PTL

always follow up 6m layer= smear (HPV and cytological assessment)

Question 2

Staging of Cervical cancers

Answer 2

Stage 1A- microscopic tumour usually incidental
stage 1B= larger, clinically invasive

stage 2-4-beyond just the cervix- need radiotherapy

Question 3

How to manage stage 1b cervical cancer (+SE)

Answer 3

if small/cervic- radial hystercotmy and pelvic node dissection

preserving fertility- Radical trachelectomy

high cure rate!

SE–bladder issues
sexual dysf
Lymphedema

Question 4

How to manage stage 2-4 cervical cancer

Answer 4

Two ways of radiotherapy–
external beam radiotherapy- over 4w

internal radiotherapy- rods of radioactive material inserted under GA-

SE of lethargy, bladder/bowel issues
skin erythema

Chemo can be added to improve cure rates