Cervical Cancer

Option List:
A. Chemotherapy
B. Interstitial radiotherapy
C. Radical hysterectomy and pelvic lymphadenectomy
D. Large loop excision of the transformation zone (LLETZ)
E. Simple hysterectomy
F. Annual smear examinations
G. No further treatment
H. Intracavitary radiotherapy chemotherapy
I. External beam radiotherapy and brachytherapy
J. Palliative multidisciplinary care
K. Laparoscopic lymphadenectomy
L. Radical trachelectomy and pelvic LN dissection
M. Chemotherapy + external beam radiotherapy and brachytherapy
N. Subtotal hysterectomy
O. Pelvic exenteration
P. Cone biopsy of the cervix
For each description below, choose the single most appropriate answer from the above list of options. Each option may be used once, more than once, or not at all.

1. A 32-year-old nulliparous lady has cancer cells found on a routine smear. Subsequent colposcopy, biopsy, EUA, MRI and cystoscopy show a lesion confined to the cervix with a maximum dimension of 5x4.8 cm. She has been trying for a pregnancy for the past 6 months. What is the most appropriate treatment option?

2. A 30-year-old nulliparous lady has a smear showing possible cancer cells. Subsequent colposcopy, biopsy, examination under anaesthesia (EUA), magnetic resonance imaging (MRI) and cystoscopy show a lesion confined to the cervix with a maximum dimension of 1.5 cm. She has been trying for a pregnancy for the past 6 months. What is the most appropriate treatment option?

3. A 56-year-old Asian lady who has never previously had a smear presents with postmenopausal bleeding. Investigations show a bulky cervical cancer with extension to the bladder mucosa and spread confined to the liver capsule. What is an appropriate treatment option?

4. A 45-year-old parous woman who has never had a smear presents with post- coital bleeding and is found to have cervical carcinoma extending to the para- metrium with left-sided hydronephrosis. What is the most appropriate treatment option?

5. A 50-year-old lady was referred to colposcopy with severe dyskaryosis. Colposcopy showed changes consistent with cervical intraepithelial neoplasia (CIN) III. LLETZ was performed. Histopathology reported a cervical tumour to a depth of 2 mm. Excisional margins were clear of the disease. What is an appropriate treatment option?