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Cervical cancer > Basics > Flashcards

Basics Flashcards

1
Q

GOG 133

A

MRI better than CT or clinical exam for detecting tumor size and uterine involvement (not as good for parametrial involvement or stroma invasion, risk of false positives for edema)

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2
Q

GOG 183

A

PET CT borderline better at detecting lymph node metastases (75% sensitivity, 98% specificity)

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3
Q

GOG 109 (Peters, SWOG 8797)

A

1st chemo-RT trial: cisplatin 70 mg/m2 + 5-FU q3wk x 4 cycles  improved PFS and OS

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4
Q

GOG 71 (Keys)

A

Lower local relapse with hysterectomy after radiation, no difference in complications, consider for large tumors?

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5
Q

GOG 123 (Keys)

A

Chemo-RT + hyst vs. RT + hyst -> higher survival at 4-years in chemo-RT+hyst

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6
Q

Landoni 1997

A

Three-fold higher risk of complications with surgery AND radiotherapy, same survival

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7
Q

Sedlis criteria

A

LVSI, stromal invasion, tumor size; 30% risk of recurrence -> 15% risk of recurrence with radiation; long-term Rotman showed 42% reduction in progression or death

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8
Q

Rotman addition to Sedlis

A

Adenocarcinoma and adenosquamous had particular benefit for radiation after radical hysterectomy

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9
Q

Peters’ criteria (GOG 109, SWOG 8797)

A

Positive margins, positive lymph nodes, microscopic involvement of parametrium; 40% risk of recurrence

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10
Q

Risk of nodal involvement with Stage IB1-IB2

A

15%

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11
Q

Risk of nodal involvement with Stage 1A1 (LVSI-)

A

0.1-0.4%

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12
Q

Risk of nodal involvement with Stage 1A1 (LVSI+) or Stage 1A2

A

8%

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13
Q

Resection of the uterosacral ligament damages what nerves?

A

Bilateral hypogastric nerves

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14
Q

Presacral lymphadenectomy can damage what nerves?

A

Superior hypogastric nerves

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15
Q

Resection of the deep vesicouterine ligaments can damage what nerves?

A

Distal part of inferior hypogastric plexus

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16
Q

Resection near the deep uterine vein can damage what nerves?

A

Inferior hypogastric plexus and splanchnic nerves

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17
Q

What is the EBRT dose in cervix?

A

40-45 Gy (180 cGy over 4-5 weeks)

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18
Q

What is the vaginal brachytherapy dose in cervix?

A

30-40 Gy

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19
Q

What is the pelvic field for cervical cancer EBRT?

A

Superior: L4-L5
Inferior: 4 cm below vaginal tumor
Lateral: 1 cm lateral to bony pelvis
Anterior: Pubic rami
Posterior: S3

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20
Q

What is Point A?

A

2 cm lateral and 2 cm superior to external os (parametrial coverage), 75-90 Gy

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21
Q

What is Point B?

A

3 cm lateral to point A (sidewall coverage), 45-65 Gy

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22
Q

What radiation dose is toxic to small bowel?

A

45 Gy

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23
Q

What radiation dose is toxic to large bowel and rectum?

A

80 Gy

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24
Q

What 5 trials established chemo-RT in cervical cancer?

A

Stage IIB-IVA: GOG 83, RTOG 9001, GOG 120
Stage IA2-IIA after surgery: GOG 109
Stage IB bulky: GOG 123

25
Q

GOG 169

A

Cisplatin vs. paclitaxel-cisplatin > improved response rate (36 vs. 19%) and PFS (1 month), no difference in OS

Stage 4B, recurrent or persistent

26
Q

GOG 179

A

Cisplatin vs. topotecan-cisplatin > improved response rate (27 vs. 13%) and PFS (3 months)

27
Q

GOG 204

A

Cisplatin AND paclitaxel vs. vinorelbine vs. gemcitabine vs. topotecan > no significant difference in response rate, trend toward OS with cisplatin-paclitaxel

28
Q

GOG 227

A

Improved PFS (3 months) with bevacizumab in recurrent cervix

29
Q

GOG 240

A

Cisplatin-paclitaxel vs. topotecan-paclitaxel +/ bevacizumab > improved OS with bevacizumab (3 months), 50% response (10% complete response)

30
Q

Cervical cancer related to Peutz-Jeuger syndrome

A

Minimal deviation adenocarcinoma, unrelated to HPV, not radiation responsive

31
Q

Nerve supply to the bladder lives where?

A

Dorsal parametria

32
Q

Small cell neuroendocrine associated with which HPV?

A

HPV 18

33
Q

Chemotherapy for neuroendocrine cervical cancer

A

Etoposide and platinum

34
Q

Utility of sentinel lymph nodes in early-stage cervical cancer

A

Sensitivity: 96.3%
Bilateral detection: 82%
(SENTRIC study)

35
Q

JCOG 0505

A

Cisplatin vs. carboplatin + paclitaxel > Identical outcomes, except if no prior cisplatin

36
Q

Utility of sentinel lymph nodes in Stage 1B2-3 cervical cancer

A

Sensitivity: 96.3%
NPV: 99%
(SENTRIC study)

37
Q

Risk of nodal metastases in Stage IB1-2 cervical cancer

A

SCC: 15%
Adenocarcinoma: 32%

38
Q

Moore criteria

A

PS > 0, pelvic disease, African-American, DFI <1 year, prior platinum exposure
Low-risk (0-1): OS 22 months
Mid-risk (2-3): OS 15 months
High-risk (4-5): OS 8 months, greatest benefit with bev?

39
Q

Risk of infrarenal metastases with positive pelvic nodes in cervical cancer

A

15%

40
Q

At what radiation dose can sterility occur?

A

15 Gy dose to the ovaries (@ age 30)

41
Q

What percent of radical trachelectomies require radical hysterectomy or adjuvant treatment?

A

15% conversion to radical hysterectomy
25% adjuvant therapy

42
Q

Key components of radical trachelectomy

A

Develop bladder flap to 3-4 cm below cervix
Dissect ureter to its insertion into bladder
Develop rectovaginal septum
Isolate cervical branch of uterine artery

43
Q

Class I Piver-Rutledge

A

Ureter: Not exposed
Uterine vessels: At the uterus
Cardinal ligament: At the uterus
Uterosacral ligament: Not stated
Vagina: Not stated

44
Q

Class II Piver-Rutledge

A

Ureter: Unroofed
Uterine vessels: At the uterus
Cardinal ligament: Medial one-half
Uterosacral ligament: Midway between uterus and sacrum
Vagina: Upper one-third

45
Q

Class III Piver-Rutledge

A

Ureter: Dissected from pubovesical ligament to bladder
Uterine vessels: At the internal iliac vessels
Cardinal ligament: At the pelvic wall
Uterosacral ligament: Excised at sacral attachment
Vagina: Upper one-half

46
Q

Class IV Piver-Rutledge

A

Ureter: Complete dissection from pubovesical ligament
Uterine vessels: If necessary, removal of internal iliac vessels
Cardinal ligament: If necessary, removal of internal iliac vessels
Uterosacral ligament: Excised at sacral attachment
Vagina: Three-fourths

47
Q

Class V Piver-Rutledge

A

Ureter: Remove portion of bladder or ureters
Uterine vessels: If necessary, removal of internal iliac vessels
Cardinal ligament: If necessary, removal of internal iliac vessels
Uterosacral ligament: Excised at sacral attachment
Vagina: Three-fourths

48
Q

Type A Querleu-Morrow (Kyoto classification)

A

Ureter: Not exposed
Uterine vessels: At uterus
Cardinal ligament: At uterus
Uterosacral ligament: At uterus
Vesciouterine ligament: Not divided
Vagina: At cervix

49
Q

Type B1 Querleu-Morrow (Kyoto classification)

A

Ureter: Unroofed
Uterine vessels: At ureteral tunnel
Cardinal ligament: At ureteral tunnel
Uterosacral ligament: Between cervix and rectum
Vesicouterine ligament: Between cervix and bladder
Vagina: 1 cm

50
Q

Type B2 Querleu-Morrow (Kyoto classification)

A

Ureter: Unroofed
Uterine vessels: At ureteral tunnel or laterally
Cardinal ligament: At ureteral tunnel, remove lymphatic tissue to origin of uterine artery
Uterosacral ligament: Between cervix and rectum
Vesicouterine ligament: Between cervix and rectum
Vagina: 1 cm

51
Q

Type C1 Querleu-Morrow (Kyoto classification)

A

Ureter: Mobilized to the bladder
Uterine vessels: Divided at origin from internal iliac vessels
Cardinal ligament: Divided at internal iliac vessels, autonomic nerves preserved (dorsal to deep uterine vein)
Uterosacral ligament: Divided at rectum
Vesicouterine ligament: Divided at bladder
Vagina: 1.5-2 cm

52
Q

Type C2 Querleu-Morrow (Kyoto classification)

A

Ureter: Mobilized to bladder
Uterine vessels: Divided at origin from internal iliac vessels
Cardinal ligament: Entire paracervix, including deep uterine vein and autonomic nerves
Uterosacral ligament: Divided at rectum
Vesicouterine ligament: Divided at bladder
Vagina: 1.5-2 cm

53
Q

What Kyoto classification radical hysterectomy is nerve-sparing?

A

Type C1 and above (avoids deep uterine vein and autonomic nerves)

54
Q

What is the difference between Kyoto/Querlue-Morrow type B1 and B2?

A

Removal of fatty nodal tissue from ureter to obturator space

55
Q

False-positive rate for pelvic nodes on imaging in cervical cancer

A

5-25%

56
Q

Risk of ovarian metastasis in early-stage cervix

A

SCC: 0.5%
Adenocarcinoma: 5%

57
Q

Risk of lymph node metastases with stage 1A2

A

2-8%

58
Q

Risk of recurrence with early stage cervical cancer

A

IA1: 1.5%
1B: 5%

59
Q

AKI definition

A

Cr +0.3 over baseline in 48 hrs
Cr +1.5 in 7 days

Cervical cancer (6 decks)

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