17) Gynae-oncology: Cervical Flashcards
Lifetime risk of cervical cancer
<1% (1 in 142)
Percentage of cervical cancer which is considered preventable
99.8%
What percentage of cervical cancer is associated with high risk HPV?
> 95%
Which are some of the high risk hpv subtypes?
16,18,31,33,35
When is HPV vaccination given?
12-13 year old girls
Which strains of HPV does the current vaccine protect against?
Gardasil - 6,11,16,18
What is the predicted effect of vaccination implementation?
50% decline in high grade CIN and 70% decline in cancer
What is the most common type of cervical cancer?
Squamous cell (70%)
What percentage of CIN1/2/3 will regress or invade?
CIN 1: 60% regress, 1% invade
CIN 2: 40% regress, 5% invade
CIN 3: 33% regress, 30% invade
Management of cervical cancer
1A1: LLETZ only
1A2: LLETZ/cone/simple hysterectomy + nodes
1B/2A: Radical hysterectomy + nodes OR radical radiotherapy (Radical trachelectomy if fertility preserving)
2B-4A: Radiotherapy and chemotherapy
4B: Palliative radiotherapy
Chance of nodal involvement in 1A1 cervical cancer
<1%
Chance of nodal involvement in 1A2 cervical cancer
5%
What percentage of women having treatment for cervical cancer have significant complications of treatment?
27%
What percentage of women experience GI complications of treatment for gynaecological cancers?
> 50%
What percentage of women experience bowel obstruction after radiotherapy for cervical cancer?
14.5%
What percentage of women experience bowel fistulae after treatment?
8%
What percentage of women have ureteric injury at time of radical hysterectomy?
1%
What percentage of women have ureteric obstruction secondary to fibrosis from radiotherapy?
1%
What percentage of women have radiation cystitis?
26%
What percentage of women have long term voiding difficulties requiring ISC?
2-3%
What percentage of women have a vesico-vaginal fistula?
<2%
When do patients with vesico-vaginal fistula usually present and how are they managed?
Usually present D5-D14 post-op and up to 50% heal with conservative management
Percentage of dyspareunia following radiotherapy for cervical cancer
55%
How often is cervical screening performed?
3 yearly 25-50, 5 yearly 50-65, after 65 only if recent abnormal smear.