Gynaecology - Neoplasm of cervix

Question 1

Cervical extropion

Cause
S/S
Management

Answer 1

Question 2

Cervical polyp

Cause
S/S
Management

Answer 2

Question 3

Cervical cancer screening program

Explain why it is suitable for screening

Answer 3

Question 4

Cervical cancer screening

Indication
Timing

Answer 4

Question 5

Management of cervical smear abnormalities in adolescence

Answer 5

Question 6

Pap smear procedure

Answer 6

Question 7

Pap smear

contraindications
Unsatisfactory smears causes

Answer 7

Question 8

HPV

Low and high risk subtypes

Answer 8

Human papilloma virus (HPV) (人類乳頭瘤病毒): >200 types identified (phylogenic tree based on L1 sequence data)

low-risk HPVs (>40): cause benign anogenital warts and LSIL → e.g. HPV6, 11

high-risk HPVs (12): cause LSIL, HSIL and CA cervix → e.g. HPV16, 18, 31, 33, 45, 51, 52, 58, 59…

note that 16+18 alone account for 25% LSIL, 50-60% HSIL, 70% CA cervix

Question 9

Clinical role of HPV DNA test

Rationale

Answer 9

Question 10

Cervical smear interpretion

Histology and cytology grading

Answer 10

Question 11

Cervical smear

Bethesda classification

Answer 11

Question 12

Work up for normal cervical smear cytology + abnormal HPV test

Answer 12

Question 13

Workup for squamous cell abnormalities on smear

Answer 13

Question 14

Workup of glandular cell abnormalities

Answer 14

Question 15

Colposcopy

Indications
Procedure

Answer 15

Question 16

Endocervical sampling

Indications
Procedure

Answer 16

Question 17

Management of LSIL/ CIN-I

Answer 17

Question 18

Management of HSIL/ CIN-II

Answer 18

Question 19

LEETZ

Procedure
Risk

Answer 19

Question 20

LEETZ

Precautions after treatment
Post-LEETZ management

Answer 20

Question 21

Management of AIS

Answer 21

Question 22

Cervical cancer

Epidemiology

Answer 22

Question 23

Cervical cancer

Risk factors

Answer 23

Question 24

Cervical cancer

Pathogenesis
Histology

Answer 24

Question 25

Cervical cancer

Clinical presentation
Route of spread

Answer 25

Question 26

Cervical cancer

History
P/E findings

Answer 26

Question 27

Cervical cancer

Diagnosis

Answer 27

Question 28

Cervical cancer

Staging

Answer 28

Question 29

Cervical cancer

Pre-treatment evaluation

Answer 29

Question 30

Cervical cancer

Treatment options for different stages

Answer 30

Question 31

Hysterectomy

Indication in cervical cancer

Answer 31

Question 32

Hysterectomy

Classification

Answer 32

Question 33

Hysterectomy

Route of resection
LN dissection field

Answer 33

Question 34

Hysterectomy

Complications

Answer 34

Question 35

Cervical cancer

Adjuvant treatments

Answer 35

Question 36

Cervical cancer

Fertility sparing management

Answer 36

Radical trachelectomy involve removal of cervix, upper 1/3 of vagina and parametrium, conserving the uterine body.

Question 37

Cervical cancer

Non-surgical treatment

Answer 37

Question 38

Cervical cancer

Post-treatment F/U and prognosis

Answer 38

Question 39

Primary prevention of cervical cancer

Answer 39

Components:
 Healthy lifestyle
 Safe sexual practice
 HPV vaccination

Question 40

HPV vaccine

• ## effectiveness

Answer 40

Effectiveness
 HPV 16/18 → nearly 70% of HPV found in CA cervix, ~50% in high-grade CIN
 bivalent vaccine (vs 16/18) → effective in preventing 100% of HPV16/18-related high-grade CIN in 10y of data
 data show mass vaccination of young females → ↓abnormal cervical cytology, high grade CIN, colposcopy exam and operative procedure for high grade CIN

Question 41

HPV vaccine

Types
Dose timing

Answer 41

Question 42

Vulva cancer

Risk factors
Pathogenesis
Clinical presentation
Investigation
Management

Answer 42

Question 43

Vaginal cancer

Risk factors
Pathogenesis
Clinical presentation
Investigation
Treatment

Answer 43