Cervical cancer

Question 1

IA1

Answer 1

stromal invasion <3 mm in depth

Question 2

IA2

Answer 2

Measured stromal invasion ≥3 mm and <5 mm in depth

Question 3

IB

Answer 3

Invasive carcinoma with measured deepest invasion ≥5 mm (greater than stage IA), lesion
limited to the cervix uteri

Question 4

IB1

Answer 4

Invasive carcinoma ≥5 mm depth of stromal invasion and
<2 cm in greatest dimension

Question 5

IB2

Answer 5

Invasive carcinoma ≥2 cm and <4 cm in greatest dimension

Question 6

IB3

Answer 6

Invasive carcinoma ≥4 cm in greatest dimension

Question 7

Stage II

Answer 7

Beyond the uterus, but not to the pelvic wall or to the lower third of the vagina

Question 8

IIA

Answer 8

Involvement limited to the upper two‐thirds of the vagina without parametrial involvement

Question 9

IIA1

Answer 9

Invasive carcinoma <4 cm in greatest dimension

Question 10

IIA2

Answer 10

Invasive carcinoma ≥4 cm in greatest dimension

Question 11

IIB

Answer 11

With parametrial involvement but not up to the pelvic wall

Question 12

Stage III

Answer 12

Extends to the pelvic wall and/or involves lower third of the vagina and/or
causes hydronephrosis or non-functioning kidney and/or involves pelvic and/or
paraaortic lymph nodes

Question 13

IIIA

Answer 13

Carcinoma involves the lower third of the vagina, with no extension to the pelvic wall

Question 14

IIIB

Answer 14

Extension to the pelvic wall and/or hydronephrosis or non‐ functioning kidney

Question 15

IIIC

Answer 15

Involvement of pelvic and/or paraaortic lymph nodes, irrespective of tumor size and
extent

Question 16

IIIC1

Answer 16

Pelvic lymph node metastasis only

Question 17

IIIC2

Answer 17

Paraaortic lymph node metastasis

Question 18

Stage IV T

Answer 18

The carcinoma has extended beyond the true pelvis or has involved (biopsy proven)
the mucosa of the bladder or rectum. A bullous edema, as such, does not permit a case to be
allotted to stage IV

Question 19

IVA

Answer 19

Spread of the growth to adjacent organs

Question 20

IVB

Answer 20

Spread to distant organs

Question 21

STAGE 1A1 Treatment

Answer 21

conization.
* If the excision margins are clear (invasive and pre-invasive), no further treatment is
necessary.
* If the excision margins are involved, further local excision should be performed or a simple
hysterectomy
* If simple hysterectomy is chosen in the presence of incomplete margins, a
repeat cone should be performed to exclude more extensive
invasive disease that could necessitate a radical hysterectomy. MRI may be helpful.
* In case of LVSI- MRH+ pelvic lymphadenectomy is recommended.

Question 22

STAGE 1A2 Treatment

Answer 22

Conisation/ RADICAL TRACHELECTOMY
* Modified Radical hysterectomy / simple hysterectomy in low risk.
* Pelvic lymphadenectomy is required.
* In those who are medically unfit, radical radiotherapy is an alternative treatment option

Question 23

STAGE 1b1 treatment

Answer 23

radical hysterectomy and bilateral pelvic lymphadenectomy(
from common- iliac to femoral canal or radical radiotherapy, with equivalent cure rates.
* Radical trachelectomy – conservative fertility-sparing surgery in young patients with good
prognostic factors: tumours with largest diameter of
<2cm, without LVSI and without lymph node involvement. Radical trachelectomy and
lymphadenectomy – recurrence rate of < 5%.
Pregnancy – 41–78% is reported.
the medically fit, younger patient is treated with surgery and the unfit, older
patient treated with radiotherapy

Question 24

Stage IB2–IVA treatment

Answer 24

• Chemo-radiation:- Radiotherapy is the primary mode of treatment, combined
  with platinum-based chemotherapy

Question 25

IB1/IIA1 in young patient

Answer 25

Radical hysterectomy with pelvic LN dissection, RT after positive LN

Question 26

ADJUVANT CHEMORADIOTHERAPY

Answer 26

considered after surgery:- If the surgical margins are close
to the tumor or the lymph nodes are involved OR
parametrium involved

Question 27

Adjuvant Radiotherapy:

Answer 27

External irradiation plus brachytherapy.
Intermediate-risk patients with any two of three factors (tumor size
more than 4 cm, lymphovascular invasion, deep stromal invasion)
require PORT
and no chemotherapy should be offered to these patients.

Question 28

Stage VI b treatment

Answer 28

Platinum based combination chemotherapy + Palliation

Question 29

FERTILITY CONSERVATION

Answer 29

r women with early-stage (stage Ib1 or less) lesions wishing to conserve fertility, a radical
trachelectomy may be offered. This involves the removal of the cervix and paracervical tissue
via a vaginal route, upper 1-2cm of the vaginal cuff and medial portions of cardinal and
uterosacral ligaments together with a lymphadenectomy, and aims to conserve the uterine body. A
Shirodkar suture is inserted simultaneously into the uterine isthmus to reduce the incidence of
cervical weakness. While successful pregnancies have been reported (with delivery by
caesarean section) there is an increased incidence of miscarriage and premature delivery.

Question 30

CHEMORADITION

Answer 30

Weekly cisplatin 50mg/m2 with daily ext beam RT( teletherapy) on OPD basis for 5 weeks (
45gyrs of RT in 25 fractions.). This is followed by overnight stay for the insertion of central
source RT ( brachy)

Question 31

5-year survival rate

Answer 31

70–90%

Question 32

positive pelvic lymph nodes reduces the survival rate by

Answer 32

50%, stage for stage,
whereas involvement of para-aortic lymph node reduces the survival by75%.

Question 33

RECURRENCE

Answer 33

13% assessment by EUA, MRI, PET-CT

Question 34

cervical smear after fertility conservative trachelectomy/ LLETZ

Answer 34

smear at six months, 12 months and yearly
for 4 years before being returned to cervical screening programme.