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3rd Year Semester 1 > cervical cancer > Flashcards

cervical cancer Flashcards

1
Q

common sites of distant spread

A

para- aortic nodes
supraclav or mediastinal nodes
bone
lungs
liver

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2
Q

epidemiology

A

-85% found in developing countries
-Mortality high there too due to little assess of screening and treatment
-incidence of cancer is higher in some ethic groups-hispanic, black and asian women

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3
Q

Aetiology
cervical cancer can be caused by
pt1

A

-persisant infection with HPV virus
it can be passed by skin to skin contact from oral,vaginal. or anal sex.

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4
Q

cervical cancer can be caused by pt 2

A

-immunosupression such as HIV which can 5x the risk
-history of sexual transmitted disease

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5
Q

cervical cancer can be caused by pt 3

A

-high parity (3 or more babies)
-early age for first born (doubles the risk)
-early age of onset of coitus
-multiple sexual partners
-oral contraceptive(combined oestrogen-progestogen-5years)
-tobacco smoking

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6
Q

Grading Systems- pre cancerous

A

-Cervical Intraepithelial Neoplasia (CIN)
-Bethesda System

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7
Q

-Cervical Intraepithelial Neoplasia (CIN)

A

different degrees of dysplasia

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8
Q

Bethesda Grading System:

A

low grade squamos intraepithelial cells=low risk HPV subtypes with a low risk of progessiing into a invasive cancer

high grade squamos intraepithelial cells=high risk PHV with a high risk of progressing into a invasive cancer

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9
Q

Grading System- CIN
what does the CIN refer to
categorised by
stages

A

-a lesion that could progress into a invasive cancer
-depth of involvement
-CIN1-CIN3

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9
Q

CIN1-
caused by
treatment

A

-caused by low risk HPV
-no tx unless persisent
-regular monitoring / smears

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10
Q

CIN 2&3
caused by
treatment

A

-considered pre true cancer
-tx required
-excision
-follow up

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11
Q

Signs and Symptoms
pt1

A

post coital spotting
intermenstrual bleeding
prominent menstrual bleeding
post menopausal bleeding- result in anemia and fatigue
Vaginal discharge with offensive smell

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12
Q

Signs and Symptoms
pt2

A

-pelvic pain or dragging sensation
-pain during sex
-blood in urine
-rectal bleeding

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13
Q

DIAGNOSTIC WORK-UP AND STAGING:
staging system

A

International Federation of Gynecology and Obstetrics (FIGO)

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14
Q

Staging- Investigative procedures pt1

A

-pelvic examination
-biopsy
a)punch biopsy
b)small loop biopsy or cone biopsy
c)Endo cervical curettage
-Colposcopy
-FBC
-liver and renal function test

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15
Q

Endo cervical curettage

A

scrapping of cells from endocervical canal to test for any abnormal cells

16
Q

Staging- Investigative procedures (imaging modalities)
pt1

A

MRI Pelvis (pelvic and abdominal)
-best method of radiological assessment of primary tumours greater thab 10mm

ultrasound
-good diagnostic accuracy

17
Q

Staging- Investigative procedures (imaging modalities)
pt2

A

-CT (abdo/pelvis)
◦ Thoracic-metastasis assessment

-PET/CT
◦accurate
◦can detect nodal mestastese less than 10mm

-Chest xray

18
Q

Clinical Staging- Investigative procedures:

A

-Hysteroscopy
-cystoscopy
-proctoscopy
-intravenous urography/pyelography

19
Q

Hysteroscopy

A

visual examination of the cervix canal and the interior part of the uterus using a thin and flexible tube

20
Q

cystoscopy

A

examines urinary bladder and urethra

21
Q

proctoscopy

A

investigates anal cavity, rectum and sigmoid colon

22
Q

Intravenous urography/pyelography

A

examine kidneys , bladder , urethra and ureter

23
Q

Histological Types

A

-70- 80% Squamous cell (epidermoid) carcinoma
-20-25% adenocarcinoma including adenosquamous

24
Q

adenocarcinoma including adenosquamous

A

-increasing particular in young women
-exposure to oestrogen, obesity and conttraceptives
-not always detected on screening

25
Q

Grading

A

Does not modify stage groups
GX: Grade cannot be assessed
G1: Well differentiated
G2: Moderatley differentiated
G3:Poorly or undifferentiated.

26
Q

Treatment Options Available

A

surgery
chemo
radiation
brachy

27
Q

Surgery

A

-primary tx of early stage cancer( stage - 1A,1B1,1B2 )
-allows lymph nodes to be assessed accurately
-ovarian function remains = no early menopause

28
Q

Sentinel Lymph Node Mapping
-what is it
-when is it used
- Recommended for
-benefits

A

-dyes and radioactive substances to identify lymph nodes that may contain tumor cells.
-stage 1cervical
-T1b1/T2a1
-decreases the need in pelvic lymphadectonomy

29
Q

Strategic Plan for T1b1/T2a1

A

aim to avoid combining treatments-
surgery and RT = highest morbidity after. tx

30
Q

Fertility Sparing procedures

A

-only offered to highly selected patients
-Not recommended for patients with neuroendocrine tumours or adenoma malignum(lack of data)

31
Q

Criteria for Adjuvant treatments

A

-if pathological risk factors are discovered after radical hysterectomy (removal of womb)
-observation is needed if patient has sedlis criteria

32
Q

sedlis criteria

A

risk factors for recurrence warranting post-hysterectomy radiation for early-stage cervical cancer

33
Q

Criteria for Adjuvant treatments:
-Post-op RT is recommended for

A

high risk disease (positive pelvic nodes & positive surgical margin).

34
Q

Neo- adjuvant chemotherapy

A

no recommended outside a clinical trial
Awaiting result of new key trial
◦ INTERLACE

35
Q

aim of interlace

A

investigate whether a short course of chemo given out weekly immediately before the standard chemoradiation
improves OS for locally advanced cervical cancer

36
Q

Chemoradiation

A

-Primary treatment of Stage IIB-IVA
-suitable for early stages if patient not suitable for surgery
-results in ovarian failure for pre-menopausal women
-ovarian transportation may be considered in women less 45

37
Q

Concurrent Chemotherapy

A

-Patients with FIGO IB2- proven effectiveness of chemoradiation to radiation alone

-Standard treatment:cisplatin 40mg/m2 IV
weekly

38
Q

Criteria for Adjuvant treatments:
Pelvic EBRT is recommended

A

w or w/o concurrent platinum based chemotherapy for patients with all
-stage IA2, IB, or IIA1 disease
-negative lymph nodes after sx
-large primary tumors, deep stromal invasion

3rd Year Semester 1 (55 decks)

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