Cervical Flashcards
HPV 16 and 18 - involved in what % of cervical cancer -1
70%
screening - <21yo
none
screening - 21-29yo
cytology alone q3y
screening - 30-65yo
preferred: HPV DNA (looks at 16 and 18) and cytology “co-testing” q5y
acceptable: cytology alone q3y (NOT annual)
screening - >65yo
none
screening - guidelines
after hysterectomy for benign dz - no screening
if HPV vax - follow std screening, no difference
if abnormal test result - follow NCCN cervical screening guideline
tx - basic concepts -surgery -4
WHEN IS CURE POSSIBLE?
primary tx,
varies with stage of dz and desire for fertility (determines surgery type),
MAJOR role in early stage (stage Ia-b, IIa) - GOAL CURE
preferred over XRT as less tox
tx - basic concepts -XRT -4
MAJOR OR MINOR ROLE?
MAJOR role in locally adv to advanced dz,
also in adjuvant setting for pts with high risk of recurrence
external beam: outside going in
internal beam: probe in cervix (can not give external beam at doses higher enough to not damage bowel and bladder) (also called intracavitary) VERY IMPT!
tx - basic concepts -chemo -3
COMMON OR LIMITED ROLE?
WHEN WOULD YOU USE CHEMO ALONE?
limited role,
- concurrent with XRT for currative tx,
- palliative tx for advanced or recurrent dz
NOT used alone in absence of metastatic dz
tx - adjuvant XRT by stage Ia-IIa -3
SURGERY THEN +/- ADJ
node neg, positive LVSI, tumor >4cm: adj XRT (cat 1) +chemosensitization (cat 2b)
LN (+) and/or +surgical margins and/or +parametria:
adj XRT +chemosens (cat 1) +/- vaginal brachy
adenosquamous OR neuroendocrine small cell histology (THESE ARE RARE):
adj XRT
primary tx - advanced stage IB2-IVA - XRT + chemosens - SOC -4
NO SURGERY BECAUSE NOT AN OPTION
WHAT SIZE IS TOO LARGE?
lesion too large to surgically resect, >4cm
external beam pelvic radiation (40-60 Gy) + vaginal brachytherapy (80-85 Gy Point A) + concurrent cis 40 mg/m2 weekly
adding chemo reduced death by 20%, 6% improvement in 5yr OS
can also use 5-FU, mitomycin, and paclitaxel (also effective) for women who can not tolerate cis (those with renal dysfunction) (NOTE ALL RADIOSENSITIZING DRUGS)
staging - effect of size and location of dz -2
> 4cm
III: if dz outside cervical area LIKE HYDRONEPHROSIS
cisplatin chemoXRT concepts
Goal 6 wks of XRT without breaks with 5-6 doses of cis (OS improves with at least 5)
start cis within 24-48h of XRT
cisplatin chemoXRT acute ADR -5
myelosuppression,
diarrhea,
electrolyte abnormalities (mostly from diarrhea),
anemia,
N, V
cisplatin chemoXRT long term ADR -3
vaginal stenosis (vaginal dialators),
menopause,
bowel obstruction / fistulas (FROM XRT FIBROSIS)