Reproduction C Grade Conditions

Question 1

What is cervical cancer ?

Answer 1

Cancer of the cervix. 80% SCC, 10% Adenocarcinoma, 10% Mixed

Question 2

What is the most common cause of cervical cancer?

Answer 2

HPV 16 and 18 are responsible for 70% of cervical cancers

Question 3

What are the risk factors for developing cervical cancer?

Answer 3

Heterosexual women 
Women with multiple sexual partners 
Smoking
Lower social class
Immunosuppression

Question 4

What is cervical intraepithelial neoplasia?

Answer 4

Disease confined to the epithelium

CIN I: disease confined to lower third of the epithelium

CIN II: disease confined to lower and middle thirds of the epithelium

CIN II: affecting the full thickening of the epidermis

Question 5

How does cervical cancer present?

Answer 5

Vaginal discharge
Bleeding
Vaginal discomfort
Urinary symptoms

Late Symptoms

• painless haematuria
• chronic urinary frequency
• painless fresh rectal bleeding
• altered bowel habit
• leg oedema, pain, hydronephrosis

Question 6

What are the signs of cervical cancer?

Answer 6

White or red patches 
Rectal examination may reveal a mass
Bimanual palpation = pelvic bulkiness
Leg oedema
Hepatomegaly

Question 7

What investigations should be done for cervical cancer?

Answer 7

Colposcopy
STI check in younger women
Cone biopsy

FBC, LFT, renal function
CT chest, abdomen and pelvis
PET
CT/MRI pelvis and abdomen

Question 8

How should cervical cancer be managed?

Answer 8

Surgical
Radiotherapy
Chemotherapy

Question 9

What is cervical screening?

Answer 9

Cervical smear test
- examination and collection of cells from cervix

Precancerous cells (dyskaryosis)

Cells tested for high risk HPV, if negative then considered negative

Performed every three years from 25-65

Question 10

What cytology results can be seen on cervical screening?

Answer 10

Inadequate (Recalled within 3 months)
Normal 
Bordeline changes
Low grade dyskaryosis 
High grade dyskaryosis (moderate)
High grade dyskaryosis (severe)
Possible invasive SCC
Possible glandular neoplasia

Question 11

What is colposcopy?

Answer 11

Inserting a speculum and using a colposcope to magnify the cervix

Epithelial lining of cervix can be stained for abnormal areas

Acetic acid = abnormal cells to be white

Iodine = normal cells stained

Punch biopsy can be performed during colposcopy

Question 12

What is the staging of cervical cancer?

Answer 12

Stage 1: Confined to cervix
Stage 2: Invades uterus or upper 2/3 of vagina
Stage 3: Invades pelvic wall or lower 1/3 of the vagina
Stage 4: Invades the bladder, rectum or beyond the pelvis