Cervical Cancer Flashcards
Incidence rate in pregnancy
0.1-12 per 10000 pregnancies
Who should have cytology follow up during pregnancy
CGIN and CIN 2/3 with involved or uncertain margins
Progression rate from pre-invasive to invasive disease in pregnancy
0.04%
Risk of haemorrhage with loop diathermy in pregnancy
25%
First line imaging in pregnancy
MRI
FIGO stage 1A
Invasive carcinoma maximum depth <5mm on microscopy
1A1 - stromal invasion <3mm
1A2 - stromal invasion >3mm
FIGO stage 1B
Deepest measured invasion >5mm confined to cervix uteri
1B1 - >5mm stromal invasion and <2cm greatest dimension
1B2 - >2cm stromal invasion and <4cm greatest dimension
1B3 - Greatest dimension >4cm
FIGO stage 2A
Involvement limited to upper 2/3rds of vagina without parametrial involvement
2A1 - invasive carcinoma <4cm in greatest dimension
2A2 - invasive carcinoma >4cm in greatest dimension
FIGO Stage 2B
With parametrial involvement but not involving pelvic side wall
FIGO stage 3
Carcinoma invades pelvic side wall/lower third of vagina and/or causes hydronephrosis or non-functioning kidney and/or involves pelvic and/or paraaortic lymph nodes
FIGO stage 2
Extends beyond uterus but is confined to upper 2/3rds of the vagina and does not involve the pelvic side wall
FIGO stage 3A
Involves lower third of vagina with no extension to pelvic side wall
FIGO stage 3B
Extension to pelvic side wall and/or hydronephrosis or non-functioning kidney
FIGO stage 3C
Involvement of pelvic or para aortic lymph nodes
3C1 - pelvic lymph nodes only
3C2 - para-aortic lymph nodes
FIGO stage 4
Carcinoma extends beyond true pelvis or involves bladder or rectal mucosa (biopsy proven)
FIGO stage 4A
Spread of the growth to adjacent organs
FIGO stage 4B
Spread to distant organs
Most common tumour type?
Squamous - 85%
Adenocarcinoma 2nd most common
Treatment of 1A1 squamous cell
Total hysterectomy OR conisation to preserve fertility
Treatment of 1A2 squamous cell
Radical hysterectomy +/- pelvic lymph node dissection
OR
Large cone biopsy + laparoscopic pelvic lymphadenectomy
Treatment of stage 1A adenocarcinoma
Hysterectomy
OR
2.5cm deep conisation + 5mm clear margin
Treatment of Stage 1B disease
Fertility sparing - radical vaginal trachectomy + laparoscopic lymphadenectomy with permanent suture at isthmus
Radical hysterectomy + bilateral pelvic lymphadenectomy + total pelvic radiotherapy + chemotherapy
Stage IIA disease treatment
Intracavitary brachy + external beam radiotherapy + chemotherapy (cisplatin/5-FU)
Radiotherapy to para-aortic nodes if primary tumour >4cm
Stage IIB treatment
Intracavitary radiotherapy + external beam therapy + chemo
Stage III and IV treatment
Palliative radio-chemotherapy
Risk of preterm birth after radical trachelectomy
25%
HPV primary screening is ____ more sensitive and _____ less specific than cytology
25%
6%
If endometrial cells are found on cervical screening, perform TV scan and endometrial biopsy in the following patients
> 40yo and more than 11 days from LMP
Recommended Depth of removal of CIN by LLETZ
CIN I - 7-10mm
CIN II - 10-15mm
CIN III - 15-25mm
HPV vaccination is predicted to have what effect on incidence of CIN and cervical cancer?
50% reduction in CIN
70% reduction in ca
Risk of pelvic lymph node metastasis with 1A2 cancer
3-6%
