Cervical cancer Flashcards
Incidence of cervical CA
4%
Symptoms for primary CA
- Usually asymptomatic till late stages
If symptomatic: - PV bleeding
- IMB
- PCB
- PMB
Symptoms for metastatic disease
- Heamaturia
- Incontinence
- Bone pain
- Lower limb oedema
- Flank or loin pain
- Weight loss
- Fatigue
Highest risk age group
- 30-45yo
- Occurs in women aged 15-44yo
RF for cervical CA
- Prev HPV
- Prev colp/treatment
- Multiple sexual partners
- Long term COCP
- Smoking
- High parity
Diagnosis
- Detailed hx
- Examine the cervix
- If abnormal appearences- refer to colp 2ww
- Only perform smear if pt has not done it in the routine time
MDT
- All pt’s w suspected or confirmed cervical CA should be discussed in MDT
Further assessment if stage >1A
- PV exam
- PR exam
- MRI for staging
MRI risks
- Perform 7-10 days after biopsy
- Biopsy can cause artefact- appear as malignancy
When to do PET scan
- If stage >1B1
- To plan for radical chemo-radiation therapy
Gold standard for staging
- Surgical staging with lymphadenectomy
Sentinel LNB
- High sensitivity in tumours <2cm
Safety yet to be established
5 year survival wo lymph node involv
92%
5 year survival w lymph node invol
64%
Marker for high risk HPV
p16
Staging of cervical CA
add image
Treatment for stage 1A1
- LLETZ or cold knife conisation
- Need to get adequate margins
Mx of stage 1A2-1B2
- Radical hysterectomy +BSO with b/l pelvic lymphadenectomy
- Consider LLETZ for stage 1A2, 1B1 w no nodes.
If pt wants to preserve fertility + SNLB to enusre no lymph spread
Mx stage 1B3-IIA2
- Try to avoid radical surgery + post op EBRT - inc risk of morbidity
- Use definitive platinum based chemo-radio +ERBT
Mx stage IIB - IVA
- Definitive chemo-radio + ERBT
- Addtional radiation boost to the involved lymph nodes
Ovarian preservation
- Can be considered till stage 1A2
Method of surgery
- Laparotomy better than laparoscopy
- Better overall survival
High risk factors for post op chemo-radiotherapy
- Positive pelvic/para-aortic lymph nodes
- Parametrial spread
- Positive surgical margins
Intermediate risk factors
- Presence of LVSI
- Tumour max size >4cm
- Deep cervical stromal invasion
SE post rx for patients
- Psychosocial - effects of QOL
- Lymphoedema
- Effects on bowel/bladder function
- Menopause and HRT
- Sexual mobidity- Impace on fertility, need for vaginal dilators
Mx of recurrence/stage 4 cancer
- MDT discussion
- Consideration of performance status and rx options
Suspected cervical CA in preg
- If suspicious cervix on examination- refer to colp
- Careful assessment +biopsy if needed
- Offer cerclage with biopsy
F/u after treatment
- Regular f/u w or wo imaging
- Most recurrence occurs in 2years
Staging cervical CA in preg
- Use MRI
- CT only if necessary, weigh the risks and benefits
- Do not perform SNLB
Mx of cervical CA in preg
- Individual plan
- Aim for localised rx and diagnosis then further rx after delivery
