Cancer Flashcards
What are the common presenting symptoms for CA cervix?
- Asymptomatic
- PV bleeding (IMB, PMB, PCB)
- Mass
- Vaginal discharge due to infected tumor
What is the radiological investigations for CA cervix?
- MRI pelvis
- CXR for metastasis
- USG abdomen and pelvis
Treatment for CA cervix?
Depends on staging:
Stage1A1 (microscopic <3mm depth): cone biopsy OR simple hysterectomy
Stage 1A2-2A: Radical hysterectomy and bilateral pelvic lymphadenectomy or RT
Stage 2B-4: Chemotherapy and radiotherapy
2 Preventive measures of CA cervix besides lifestyle measurement?
- Regular pap smear
2. HPV vaccination
How will you explain results of HSIL in pap smear to patient?
- Neoplastic changes at cells of squamocolumnar junction
2. HSIL is microinvasive condition but not cancer, but can progress to SCC
Colposcopy shows extensive acetowhite lesions on cervix and vagina is not involved. Multiple biopsies show early
stromal invasion. How would you advise this patient?
Already a carcinoma, stage 1A (with microscopic invasion) <3mm= 1A1
- Requires microscopy to see for depth of invasion; if >3mm = stage1A2, which then requires radical hysterectomy + bilateral pelvic lymphadectomy or chemo RT (rather than cone biopsy OR simple hysterectomy)
If a patient has cone biopsy done, showing frank invasive and carcinoma of stage IBI. What would you do before deciding on the
definite treatment? (4)
- MRI pelvis to confirm operability of Ca, any soft tissue involvement or parametrium (stage 2b),
- non-operative if gross hydronephrosis, not intact pelvic wall, obturator lymphadenopathy - CXR for any metastasis
- Patient factor: whether patient is fit for surgery or not
If a patient has cone biopsy done, showing frank invasive and carcinoma of stage IBI. How to counsel the patient?
- If the patient has no fertility wish, advise radical hysterectomy + BSO + lymphadenectomy
Discuss the pros and cons of surgery and radiotherapy in Ca cervix. Which treatment would you recommend?
Surgery Pros - specimen for histology, - check for margin involvement, - lowers risk of recurrence - lowers risk of ovarian cancer
Cons
- Infection, bleeding,
- injury to other organs,
- lymphedema,
- fistula,
- surgical menopause,
- infertility,
- GA risk
Radiotherapy
Pros
- more tolerable, non-invasive, no GA risk
Cons
- Loss of ovarian function, vaginal stenosis, cystitis, proctitis,
lead to secondary malignancy, will not be eligible for 2nd RT, no specimen for histology
Prefer surgery for younger patient, RT for older patient (same survival)
What is radical trachelectomy?
When it can be done?
- Resection of cervix +/- some vagina, then connects uterine body to remaining vagina + lymphadectomuy
- When tumor <2cm, SCC only (not adenocarcinoma because requires resection of some uterine body)
What are the pros and cons of radical trachelectomy?
Pros: fertility sparing as functional uterine body is retained
Cons:
- Higher chance of abortion
- Higher chance of needing ART
- Requires cerclage in the next pregnancy
Indications for colposcopy?
Abnormal pap smear findings
e.g. LSIL, HSIL, cancer
- Refer to colposcopy if:
1. ASCUS or above x2 at 6 months/12 months of PS
2. ASC-H
3. LSIL > triage with HPV testing if haven’t done, then colposcopy + biopsy if HPV +ve ; 1 year after if HPV -ve
4. HSIL in 6 weeks + biopsy
5. Carcinoma in 1 week + biopsy
Name the solution used in colposcopy.
Acetic acid +/- Lugol’s iodine
- then use Monsel’s solution for hemostasis if needed
Describe possible abnormalities found in colposcopy (4). (esp found in high grade CIN)
- Patches of acetowhite
- Punctations
- Mosaic vascular pattern
- Ulcerations
Best treatment for a 29/F lady with 2 children for HSIL findings in colposcopy.
LEEP
- Loop electrosurgical excision procedure
