Carcinoma Cervix MCQs

Pap smear is only a screening test. To confirm we need to do a biopsy. In all visible lesions punch biopsy should be done In the case of invisible lesions, colposcopic directed biopsy is the gold standard. Thus, in this case since it is not mentioned growth is visible so we do colposcopy guided biopsy. Reference: Williams Gynecology 1 st /ed pg 628, Table 29-6

Bilateral involvement and malignant ascites is seen in category IC. In IC also- according to the new classification it is IC 3. Superficial liver metastasis is included in Stage III. Metastasis to liver parenchyma is included in Stage IV. Reference : Novak 14 th /ed pg 1477; Shaw 15 th /ed pg 427

"Carcinoma in situ (stage 0) can be managed successfully by cone biopsy or by abdominal hysterectomy." Reference : Harrison 17 th /ed pg 608 Friends, carcinoma in situ is managed in young women with cone biopsy, whereas in older women or females who had completed their families (> 40 years), simple hysterectomy is the TOC. Reference : Harrison 17 th /ed pg 608; Reference : Novak 14 th /ed pg 581; Reference : Jeffcoate 6 th /ed pg 398

Factors Predisposing to CIN/Ca cervix: Human Papillomavirus infection Sexually transmitted infection Coitus before 18 years of age Multiple sex partners Multiparity Poor personal hygiene Poor socioeconomic status Smoking, Immunosuppressed individuals Women on OCP, Progesterone therapy for a long time are predisposed to adenocarcinoma of endocervix. In utero exposure to DES "HPV is central to the development of cervical neoplasia. HPV - DNA is found in 95% of all squamous cell carcinoma & 90% of all adenocarcinomas." Reference : Novak 15 th /ed pg 1306.

HPV triage strategies are used to determine the next step in cervical cancer screening when HPV is detected. These strategies typically involve Conventional Pap smear (A) - Used for cytological evaluation of cervical cells. Liquid-based cytology (B) - A more advanced method of cytology that improves sample quality. Hybrid Capture 2 (HC2) for HPV DNA (C) - A molecular test used to detect high-risk HPV DNA. Colposcopy (D) is not a triage strategy but rather a diagnostic procedure performed if abnormal cytology or persistent high-risk HPV is found Reference : Dutta Gynae 6 th /ed pg 323-4

Cesarean Section is not indicated in all cases of abruptio placentae. 'An attempt at vaginal delivery is indicated if the degree of separation appears to be limited and if continuous FHR tracing is reassuring. When the placental separation is extensive but the fetus is dead or of dubious viability, vaginal delivery is indicated'. - COGDT 10/e, p 334 In carcinoma cervix, classical cesarean section should be done, vaginal delivery should not be allowed because of cervical dystocia and injuries. - Dutta Obs. 7/e, p 308 Cesarean section is indicated in an active primary genital HSV infection where the membranes are intact or recently ruptured. - Dutta Obs. 7/e, p 300 In a severe degree of placenta previa (Type II posterior, Type III or Type IV), cesarean section is indicated for maternal interest even if the baby is dead. Reference : Dutta Obs. 7/e, p 308, 301, 250; COGDT 10/e, p 334

There are various nomenclatures/classification systems for reporting of Pap smear. The one which is classically used is by WHO, which uses the terms CIN-I, CIN-II and CIN-III. Another system as discussed earlier is Bethesda which classified the disease as LSIL=low grade squamous intraepithelial lesion and HSIL high grade squamous intraepithelial lesion and as discussed in chapter on cancer cervix chances of progressing to cancer are maximum with HSIL which includes CIN11, CIN111 and Ca in situ Reference: Shaw 15 th /ed p 402; Williams Gynae 1 st /ed p 629

44 years old patient presenting with post coital bleeding and positive pap smear raises suspicion of carcinoma cervix / CIN which needs to be confirmed (as pap smear is only a screening procedure). In the question it is not mentioned whether lesion is visible nor the size of lesion is given so we take it to be invisible. As already discussed for invisible lesions, colposcopy should be done to confirm the diagnosis. Reference : Williams Gynae 1 st /ed pg 628, Table 29.6