5. Cancer of the cervix:

Home Page

MCQ Papers 1-5

Sample MCQs

 

a. has reduced in incidence due to cervical screening programmes True
b. cigarette smoking is a risk factor True
c. has been shown to be due to HPV type 16 False
d. the incidence is inversely related to social class True
e. the risk is related to the partner's occupation True
f. is more common in women with an early menarche False
g. is always apparent on cervical cytology False
h. is usually adenocarcinoma False
i. is usually treated with radiotherapy False
j. has peak incidence at age 40 - 50 years False

 

See also MCQ Paper 1, question 37, MCQ Paper 2, question 24, MCQ5, question 48, and MCQ11, question 49.

 

The aetiology of cervical cancer is not fully understood.

 

But HPV infection is thought to be implicated in almost every case and the main aetiological factor.

 

Type 16 is thought to be the main villain in the western world.

 

More than 30 other HPV  types are implicated too, particularly 18, 31 and 33.

 

Some countries have markedly different virus incidences compared to the west.

 

For example, Indonesia, where cervical cancer is the most common female cancer.

 

There the commonest virus type is 52, followed by 16 and 18, which are similar in incidence.

 

But nobody is going to ask you in the DRCOG.

 

HPV's role applies to both squamous and adenocarcinoma.

 

The disease is markedly related to social class, more so than most cancers.

 

We all know about:

 

    age at first coitus,

 

    multiple partners (over time, not 'ten in a bed', though I guess 10  in a bed would transmit just as much, or even more, virus),

 

    and non-barrier contraception.

 

The partner is a significant risk factor, particularly sailors, long-distance lorry drivers etc.

 

Apparently commercial travellers are not as high risk as one might anticipate.

 

Perhaps they are just too boring to get suitable opportunities for hanky panky. 

 

Cigarette smoking increases the risk. 

 

I suspect that God made it so in order that lecturers could utilise the ancient joke:

 

    -"Do you smoke after intercourse?" - 

     "I don't know. I've never looked doctor".

 

It's so absurd it always makes me chuckle!

 

The effect of screening programmes has been the subject of debate.

 

But most authorities  accept that screening is effective and that the the incidence of cervical cancer has fallen significantly as a result.

 

Comparing rates of occurrence of the disease now with previous decades is problematic.

 

Major changes like the number of sexual partners and greater use of non-barrier contraception greatly influence the risk of the disease.

 

These social changes should have led to an increased incidence.

 

So there is an argument that the reduced incidence is a triumph of screening when a marked increase might have been anticipated.

 

There are also still a minority of women who do not take part in screening.

 

False negative smears do occur, for which reason some have advocated that the first smear should be followed by a second one year later.

 

The histology is mostly squamous carcinoma.

 

We used to teach that only ~ about 5% was adenocarcinoma.

 

The incidence of adenocarcinoma has risen.

 

The reason is not clear, but the incidence is now ~ 15%.

 

Cervical cancer incidence shows two peaks.

 

The first is in women between the ages of 30 - 40, the second in women > 80 years.

 

 

Most disease is detected at an early enough stage for surgery - Wertheim's hysterectomy.

 

This involves removal of the uterus, paracervical tissue and pelvic lymph nodes.

 

Vaccination of girls against the wart virus was introduced in the UK from 2008.

 

For more information, see question 12.

 

Next question
Return to MCQ5, answer 48: "Cervical cancer"
Return to MCQ 11, answer 49: "HPV"
Return to "Sample MCQs"

Return to "MCQs in the Information Booklet"

List of topics covered by the MCQs

DRCOG Page

MRCOG Page

Home Page