Cervical cancer

Question 1

Incidence of cervical CA

Answer 1

4%

Question 2

Symptoms for primary CA

Answer 2

• Usually asymptomatic till late stages
  If symptomatic:
• PV bleeding
• IMB
• PCB
• PMB

Question 3

Symptoms for metastatic disease

Answer 3

• Heamaturia
• Incontinence
• Bone pain
• Lower limb oedema
• Flank or loin pain
• Weight loss
• Fatigue

Question 4

Highest risk age group

Answer 4

• 30-45yo
• Occurs in women aged 15-44yo

Question 5

RF for cervical CA

Answer 5

• Prev HPV
• Prev colp/treatment
• Multiple sexual partners
• Long term COCP
• Smoking
• High parity

Question 6

Diagnosis

Answer 6

• 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

Question 7

MDT

Answer 7

• All pt’s w suspected or confirmed cervical CA should be discussed in MDT

Question 8

Further assessment if stage >1A

Answer 8

• PV exam
• PR exam
• MRI for staging

Question 9

MRI risks

Answer 9

• Perform 7-10 days after biopsy
• Biopsy can cause artefact- appear as malignancy

Question 10

When to do PET scan

Answer 10

• If stage >1B1
• To plan for radical chemo-radiation therapy

Question 11

Gold standard for staging

Answer 11

• Surgical staging with lymphadenectomy

Question 12

Sentinel LNB

Answer 12

• High sensitivity in tumours <2cm

Safety yet to be established

Question 13

5 year survival wo lymph node involv

Answer 13

92%

Question 14

5 year survival w lymph node invol

Answer 14

64%

Question 15

Marker for high risk HPV

Answer 15

p16

Question 16

Staging of cervical CA

Answer 16

add image

Question 17

Treatment for stage 1A1

Answer 17

• LLETZ or cold knife conisation
• Need to get adequate margins

Question 18

Mx of stage 1A2-1B2

Answer 18

• 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

Question 19

Mx stage 1B3-IIA2

Answer 19

• Try to avoid radical surgery + post op EBRT - inc risk of morbidity
• Use definitive platinum based chemo-radio +ERBT

Question 20

Mx stage IIB - IVA

Answer 20

• Definitive chemo-radio + ERBT
• Addtional radiation boost to the involved lymph nodes

Question 21

Ovarian preservation

Answer 21

• Can be considered till stage 1A2

Question 22

Method of surgery

Answer 22

• Laparotomy better than laparoscopy
• Better overall survival

Question 23

High risk factors for post op chemo-radiotherapy

Answer 23

• Positive pelvic/para-aortic lymph nodes
• Parametrial spread
• Positive surgical margins

Question 24

Intermediate risk factors

Answer 24

• Presence of LVSI
• Tumour max size >4cm
• Deep cervical stromal invasion

Question 25

SE post rx for patients

Answer 25

• Psychosocial - effects of QOL
• Lymphoedema
• Effects on bowel/bladder function
• Menopause and HRT
• Sexual mobidity- Impace on fertility, need for vaginal dilators

Question 26

Mx of recurrence/stage 4 cancer

Answer 26

• MDT discussion
• Consideration of performance status and rx options

Question 27

Suspected cervical CA in preg

Answer 27

• If suspicious cervix on examination- refer to colp
• Careful assessment +biopsy if needed
• Offer cerclage with biopsy

Question 28

F/u after treatment

Answer 28

• Regular f/u w or wo imaging
• Most recurrence occurs in 2years

Question 29

Staging cervical CA in preg

Answer 29

• Use MRI
• CT only if necessary, weigh the risks and benefits
• Do not perform SNLB

Question 30

Mx of cervical CA in preg

Answer 30

• Individual plan
• Aim for localised rx and diagnosis then further rx after delivery