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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
GOG 169
Cisplatin vs. paclitaxel-cisplatin > improved response rate (36 vs. 19%) and PFS (1 month), no difference in OS Stage 4B, recurrent or persistent
26
GOG 179
Cisplatin vs. topotecan-cisplatin > improved response rate (27 vs. 13%) and PFS (3 months)
27
GOG 204
Cisplatin AND paclitaxel vs. vinorelbine vs. gemcitabine vs. topotecan > no significant difference in response rate, trend toward OS with cisplatin-paclitaxel
28
GOG 227
Improved PFS (3 months) with bevacizumab in recurrent cervix
29
GOG 240
Cisplatin-paclitaxel vs. topotecan-paclitaxel +/ bevacizumab > improved OS with bevacizumab (3 months), 50% response (10% complete response)
30
Cervical cancer related to Peutz-Jeuger syndrome
Minimal deviation adenocarcinoma, unrelated to HPV, not radiation responsive
31
Nerve supply to the bladder lives where?
Dorsal parametria
32
Small cell neuroendocrine associated with which HPV?
HPV 18
33
Chemotherapy for neuroendocrine cervical cancer
Etoposide and platinum
34
Utility of sentinel lymph nodes in early-stage cervical cancer
Sensitivity: 96.3% Bilateral detection: 82% (SENTRIC study)
35
JCOG 0505
Cisplatin vs. carboplatin + paclitaxel > Identical outcomes, except if no prior cisplatin
36
Utility of sentinel lymph nodes in Stage 1B2-3 cervical cancer
Sensitivity: 96.3% NPV: 99% (SENTRIC study)
37
Risk of nodal metastases in Stage IB1-2 cervical cancer
SCC: 15% Adenocarcinoma: 32%
38
Moore criteria
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
Risk of infrarenal metastases with positive pelvic nodes in cervical cancer
15%
40
At what radiation dose can sterility occur?
15 Gy dose to the ovaries (@ age 30)
41
What percent of radical trachelectomies require radical hysterectomy or adjuvant treatment?
15% conversion to radical hysterectomy 25% adjuvant therapy
42
Key components of radical trachelectomy
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
Class I Piver-Rutledge
Ureter: Not exposed Uterine vessels: At the uterus Cardinal ligament: At the uterus Uterosacral ligament: Not stated Vagina: Not stated
44
Class II Piver-Rutledge
Ureter: Unroofed Uterine vessels: At the uterus Cardinal ligament: Medial one-half Uterosacral ligament: Midway between uterus and sacrum Vagina: Upper one-third
45
Class III Piver-Rutledge
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
Class IV Piver-Rutledge
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
Class V Piver-Rutledge
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
Type A Querleu-Morrow (Kyoto classification)
Ureter: Not exposed Uterine vessels: At uterus Cardinal ligament: At uterus Uterosacral ligament: At uterus Vesciouterine ligament: Not divided Vagina: At cervix
49
Type B1 Querleu-Morrow (Kyoto classification)
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
Type B2 Querleu-Morrow (Kyoto classification)
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
Type C1 Querleu-Morrow (Kyoto classification)
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
Type C2 Querleu-Morrow (Kyoto classification)
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
What Kyoto classification radical hysterectomy is nerve-sparing?
Type C1 and above (avoids deep uterine vein and autonomic nerves)
54
What is the difference between Kyoto/Querlue-Morrow type B1 and B2?
Removal of fatty nodal tissue from ureter to obturator space
55
False-positive rate for pelvic nodes on imaging in cervical cancer
5-25%
56
Risk of ovarian metastasis in early-stage cervix
SCC: 0.5% Adenocarcinoma: 5%
57
Risk of lymph node metastases with stage 1A2
2-8%
58
Risk of recurrence with early stage cervical cancer
IA1: 1.5% 1B: 5%
59
AKI definition
Cr +0.3 over baseline in 48 hrs Cr +1.5 in 7 days

Cervical cancer (6 decks)

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