Question 8: Cervical Cancer

Question 1

What are the presenting symptoms of cervical cancer?

Answer 1

Can be asymptomatic
Abnormal vaginal bleeding: Intermenstrual bleeding, post-coital bleeding, irregular bleeding, postmenopausal bleeding
Offensive vaginal discharge
Pelvic pain
Rectovaginal fistula
Symptoms due to metastases

Question 2

What investigations are done for suspected cervical cancer?

Answer 2

Biopsy of abnormal lesions
Renal function tests (to assess kidney involvement)
Liver function tests (to check for metastases)
Chest X-ray (to assess for lung metastases)
Ultrasound of ureters and kidneys (to check for obstruction)
Cystoscopy (if bladder involvement is suspected)

Question 3

What should be done if an abnormal cervical lesion is found?

Answer 3

Do NOT perform a PAP smear
Perform a punch biopsy for histological diagnosis

Question 4

Stage 1 cervical cancer

Answer 4

Stage 1: Confined to the cervix

1A: Tumor ≤5mm depth
1A1: ≤3mm → Conization
1A2: 3-5mm → Modified radical hysterectomy

1B: Tumor >5mm
1B1: ≤2cm
1B2: 2-4cm
Treatment: Chemoradiation

Question 5

Stage 2 cervical cancer

Answer 5

2A: Involves upper 2/3 of the vagina
2B: Involves parametrium but not reaching pelvic sidewall

Question 6

Stage 3 cervical cancer

Answer 6

3A: Involves lower third of the vagina
3B: Extends to pelvic sidewall or causes hydronephrosis
3C: Lymph node involvement

Question 7

Stage 4 cervical cancer

Answer 7

4A: Involves bladder or bowel
4B: Distant metastases