Cervical Cancer Flashcards
Stage 1A1 cervical cancer
Microscopic stromal invasion = 3 mm in depth
Stage 1A2 cervical cancer
Microscopic stromal invasion >3mm =5mm in depth
Stage 1B1cervical cancer
Macroscopic lesion limited to cervix
Invasion >5mm depth
=2cm dimension
Stage 1B2 cervical ca
Dimension >2cm and =4cm
Stage 1B3 cervical cancer
Dimension >4cm
Stage 2A1cervical ca
Upper 2/3 vagina without parametric
= 4cm
Stage 2A2 cervical ca
Upper 2/3 vagina , no parametrium
>4cm dimension
Stage 2B cervical ca
Paramatrium involved but not pelvic side wall
Stage 3A1 cervical ca
Lower 1/3 of vagina , no pelvic side wall
Stage 3B cervical ca
Pelvic side wall +/- hydronephosis or non functioning kidney
Stage 3C1cervical ca
Pelvic nodes involved
Stage 3C2 cervical ca
Para aortic nodes involved
Stage 4A cervical ca
Spread to bladder or rectal mucosa
Stage 4B cervical ca
Distant metastasis
What cancers type has metastasis to the ovary
Adenocarcinoma
Treatment of stage 1A1 cervical cancer
- fertility sparing : conization 3mm margin 10mm depth
- no fertility: extra fascial hysterectomy
- LVSI:
A) modified radical hysterectomy + PLND
B) fertility sparing: trachelectomy/cone biopsy + PLND
Stage 1A2 treatment cervix
Fertility desires: conization or trachelectomy
No fertility: type B radical hysterectomy
Or
Pelvic EBRT + brachytherapy
Lymph node dissection up to inferior mesenteric
Stage 1B1 TX cervix
Fertility desires: radical trachelectomy + PLND
No fertility: Type C radical + PLND
Stage 1B2 and 2A1 TX cervix
- Type C radical hysterectomy + PLND
Or - Pelvic EBRT + bracytherapy +/- platinum chemotherapy
Stage 1B3 and 2A2 TX cervix
Not surgical candidates
- pelvic EBRT + Plat chemo + brachytherapy
If radiotherapy not available
- radical hysterectomy + LND
What was the LACC trial
Evaluation of minimally invasive surgery vs open for cervical cancer
Findings
- shorter overall survival eith minimal approach
Treatment of stage 2B and above cervix
- primary chemoradiotherapy
Resource limited
- rad hyste or Neoad chemo followed by rad hyste
Management of ASCUS (<25yrs)
- Repeat smear in 12mnths x 2
- persistent x 2 years: colposcopy
- triage hpv testing acceptable
Management of ASCUS >25YRS
- triage HPV testing
Pos: colposcopy
Neg: routine screening - repeate in 12mnths acceptable x 1
(Persistent or worse colpo)
LSIL management
<25yrs :Repeat in 12 months
> 25yrs: colposcopy
HSIL
Colposcopy
ASC-H
Colposcopy
AGS
Colposcopy + ECC
Endometrial sampling is high risk or >35years
Unsatisfactory smear
X1 : repeat in 2-4mnths
X2 : colposcopy
If >25 and hpv pos: repeat or colposcopy
Negative smear, absent TZ
Routine screening
Hpv testing preferred if >25 yrs
Management of CIN1
<25 Years
-Preceeding smear : ASC-H/HSIL= observation
- colpsocopy and cytology yearly for 2 years
Progression risk of CIN1
HSIL- CIN1- CIN3+ = 3.9%
ASC-H - CIN1- CIN3+= 1.4%
CIN 1 management >25 yrs
Preceeding pap
-HSIL: excisional treatment
-ASC-H: HPV testing 1 and 2 yrs
Negative- routine screening
Pos colposcopy
Treat if persistent
CIN 2 <25 yrs
Observation
Colposcopy and cytology 6mnths 1year 2 year
CIN 2 >25yrs
Treatment
Followup
6mnths 1 year 2 years
CIN 2 in pregnancy
Surveillance testing
Colpsocopy , cytology +/- hpv every 12 - 24 weeks
Progression of CIN2
50% regress (60% if <30)
30% persist
20% progress to CIN 3+
CIN 3 treatment
Treatment for both age groups
Follow up
- hpv testing 6mthn 1year 2year
If all neg
- 3yearly x 25yrs
What is are the different types of hpv vaccines and what do they cover
1) cervarix: bivalent vaccine covered hpv 16,18
2) gardasil: quadravalent covers 6,11,16,18
3) gardasil 9: nonavalent covers 6,11,16,18,31,33,45,52,58
What age is the vaccine ideally targeted to
Boys and Girls age 12-13
What is the vaccination schedule
Two doses at least 6mnths apart.
If immunocomprosided or >15yrs would require 3 doses
2nd dose 1mnth after 1st
3rd dose 3mnths after 2nd
