O&G Written - Cervical disorders

Question 1

Routine Smear Schedule

Answer 1

25-45 cervical smear every 3 years

45+ every 5 years

65+, only those not screened since 50yo OR recent abnormal result are screened

Question 2

HPV +, cytology -

Next steps?

Answer 2

Repeat cervical smear 12 months

If HPV +ve, cytology - THEN repeat again at 12 months
If HPV +ve, cytology + THEN colposcopy
If HPV -ve THEN return to normal recall

Question 3

Rules for inadequate cervical smear sample

Answer 3

Inadequate sample - repeat in 3 months

2-3 insufficient samples THEN colposcopy

Question 4

Gold standard Tx for Stage 1a cervical ca.

Answer 4

Hysterectomy +/- lymph node clearance

BUT may not be appropriate if young + wanting fertility preserved

Question 5

Tx options for stage 1a cervical ca.

Answer 5

Cone biopsy with clear margins
Radical trachelectomy
Hysterectomy +/- lymph node clearance

Question 6

Tx options for later stage cervical ca.

Answer 6

Radical hysterectomy + pelvic lymph node dissection

Radiotherapy + cisplatin chemotherapy
- preferred in LN involvement

Question 7

Complications of Tx for CIN or cervical ca.

Answer 7

Pre-term birth with LLETZ or cone biopsy

May need cervical cerclage (suture)

Question 8

Risk factors for CIN / cervical ca.

Answer 8

COCP
Multiple sexual partners + early first intercourse
HPV - serotypes 16, 18, 33 especially
Smoking
HIV & immunosuppression
Lower socioeconomic status
High parity