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Cervical cancer: screening, precancer and staging
Almost every cervical cancer is caused by persistent high-risk HPV infection; screening looks for the precancerous stage (CIN), colposcopy and biopsy make the diagnosis, and treatment follows the grade of the lesion or the FIGO stage.
Why it matters in the exam
This is one of the most frequent gynaecology topics in the exam. Questions give a smear result (ASC-US, LSIL, HSIL, AGC) or an HPV result and ask for the next step: repeat testing, an HPV test, colposcopy or a loop excision (LEEP). The newer principle is risk-based management: not only the current result counts, but also the history and the HPV type, and a positive HPV 16 or 18 leads to colposcopy even when the smear is normal.
The second part of the questions concerns the cancer itself: the risk factors (HPV, smoking, immunosuppression, multiple partners), the classic symptom of postcoital bleeding, and the FIGO stages. Know that hydronephrosis caused by the tumour raises the stage to III, that lymph node involvement is stage IIIC, and that locally advanced disease is treated with chemoradiation with cisplatin rather than surgery. In pregnancy colposcopy and biopsy are allowed, but not endocervical curettage and not treatment of CIN unless invasion is suspected. The HPV vaccine is given in Israel through the school programme and remains important even for women who are screened.
Key points
- High-risk HPV is the cause; smoking and immunosuppression raise the risk.
- Screening at 25–65, preferably primary HPV testing every 5 years.
- HPV 16/18 or HSIL → colposcopy; CIN2-3 → loop excision.
- Stage III includes hydronephrosis and nodes (IIIC).
- Locally advanced (IB3 and above) → chemoradiation with cisplatin.
Summary table
| Finding or stage | Meaning | Next step | Exam notes |
|---|---|---|---|
| ASC-US | Atypical cells of uncertain significance | HPV test; if positive → colposcopy | Under age 25 — repeat the smear after one year |
| LSIL or CIN1 | Usually a transient HPV infection | Colposcopy; CIN1 → surveillance | Most lesions regress on their own, especially in young women |
| HSIL or CIN2-3 | A true precancerous lesion | Colposcopy or immediate loop excision (LEEP) from age 25 | In pregnancy — surveillance without treatment until after delivery, unless invasion is suspected |
| AGC | Atypical glandular cells | Colposcopy, endocervical sampling, and endometrial sampling from age 35 | May hide endometrial disease |
| Stage I | Confined to the cervix; IA microscopic up to 5 mm deep | Radical hysterectomy, or conisation for a very small lesion | Fertility preservation is possible in early disease |
| Stage II-IV | II: beyond the uterus; III: pelvic wall, lower third of the vagina, hydronephrosis or nodes (IIIC); IV: bladder, rectum or distant spread | Chemoradiation with cisplatin from stage IB3 upward | Hydronephrosis = at least stage III |
Free exam questions
באיזה שלב מחלה של ממאירות צ ו ואר הרחם, ללא חדירה לכלי דם וכלי לימפה, מתאים לבצע כריתת וצ ואר רדיקאלית RADICAL TRACHELECTOMY במטרה של שימור פיריון ? (the question as examined, in Hebrew)
- א. I-A-1
- ב. I-B-1
- ג. I-B-2
- ד. I-B-3
( מדענית יצאה בפרסום כי היא פיתחה בדיקת סיקור screening ) לסרטן הלבלב, סרטן קטלני שעדיין אין לו טיפול יעיל. לתבחין יש רגישות וסגוליות של 90% . במשרד הבריאות הוחלט לסרוק את כל המבוגרים במדינת ישראל בני 45-84 שנים , ובשלב זה עדיין לא הוחלט על תדירות הבדיקות. מה צפוי שימצא לגבי המאפיינים של המחלה בתום השנה הראשונה לביצוע הבדיקה? (the question as examined, in Hebrew)
- א. ( עליה בהשרדות לשנה one year survival) בחולי סרטן לבלב
- ב. ירידה בהארעות סרטן הלבלב בשנה שבה בוצעה הסריקה
- ג. ירידה בשיעורי המצאות סרטן הלבלב בשנה לאחר ביצוע הסריקה
- ד. עליה בהארעות של פנקראטיטיס, שמהווה גורם סיכון לסרטן הלבלב
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Sources
- ASCCP Risk-Based Management Consensus Guidelines, 2019 — Abnormal cervical cancer screening tests and cancer precursors
- USPSTF Recommendation Statement, 2018 — Screening for Cervical Cancer
- FIGO Cancer Report, 2018 staging, revised 2019 — Cancer of the cervix uteri
- Berek and Novak's Gynecology, 16th edition (2019) — Cervical and Vaginal Cancer
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-02. The text may contain errors; when in doubt, check the source.