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Q1: Pathogenesis (2 min)
"Describe the molecular pathogenesis of cervical cancer."
- HPV 16 and 18 infect transformation zone (squamocolumnar junction)
- E6 oncoprotein degrades p53 (blocks apoptosis)
- E7 oncoprotein inactivates Rb (removes cell cycle brake)
- Persistent infection → CIN → invasive carcinoma over 10 to 15 years
- 80% clear HPV in 1-2 years; 20% persist → progression
Q2: Screening (2 min)
"Describe the screening programme for cervical cancer."
- Pap smear every 3 years (age 25 to 49) or HPV co-testing every 5 years (50 to 64)
- Abnormal Pap → colposcopy → directed biopsy → histology
- HPV vaccination (Gardasil 9) before sexual debut — prevents 70%
- Vaccinated women still need screening
Q3: Staging and treatment (3 min)
"Stage and treat cervical cancer."
- FIGO staging is CLINICAL (pelvic exam, EUA, cystoscopy, proctoscopy)
- Stage I (cervix): surgery (Wertheim) or chemoradiotherapy
- Stage IA (microscopic): cone or simple hysterectomy
- Stage IB (visible): radical hysterectomy + pelvic nodes OR chemoradiotherapy
- Stage II to IVA (locally advanced): chemoradiotherapy (cisplatin + EBRT + brachy)
- Stage IVB (distant): palliative chemo (cisplatin + paclitaxel ± bevacizumab)
- Fertility-sparing: radical trachelectomy (early stage)
Q4: Prevention (2 min)
"How do you prevent cervical cancer?"
- HPV vaccination (before sexual debut, age 9 to 14 ideally)
- Regular cervical screening (Pap + HPV co-testing)
- Smoking cessation (reduces HPV persistence)
- Safe sexual practices (reduces HPV transmission)