Cervical Cancer Flashcards
What are some of the main risk factors seen with Cervical Cancer?
HPV (high risk types: 16 and 18), immunosuppression, HIV, smoking, early coitus, high risk sexual partner.
For stage I cervical cancer how is this primarily treated?
In general the tx strategy is surgery +/- RT depending on if they have high risk pathologic features.
What are the high risk features should be absent if the patient desires fertility preservation?
Tumor>2cm, LVI, lymph node involvement, endocervical extension
What are the high risk features that would determine for Stage IA/IB/IA2-IB2 that patients need adjuvant therapy?
Positive surgical margins, positive pelvic or para-aortic nodes, extension to the parametria.GW slide mentioned deep cervical stromal invasion
In general, what are the options for early stage (Stage IA1-2, IB1 and IB2) who desire fertility preservation?
Cone biopsy with negative margins + pelvic lymphadenectomy or radical trachelectomy+ pelvic lymphadenectomy
For Stage IA1-2 with LVSI what are the treatment options?
You can do a radical hysterectomy with pelvic lymphadenectomy or EBRT w/vaginal brachytherapy.
For any cervical tumor that is 4cm or higher but limited to the cervical uteri? What is the tx? What stages does this correspond to?
They are no longer candidates for surgery, they will need chemo/RT. This includes pelvic EBRT+chemo+brachytherapy. This is Stage IB3. Take note here that EBRT w/cisplatin and brachytherapy is Cat 1 Rec! However radical hysterectomy w/pelvic node dissection is a Cat 2B rec.
What adjuvant tx is given for those patients with early stage cervical cancer after surgery w/high risk features?
EBRT with Cisplatin +/- Vaginal brachytherapy
When a patient has a localized distant metastatic recurrence what can be offered?
You can consider resection +/- EBRT or local ablative therapies +/- EBRT. You can also consider EBRT +/- concurrent chemo. NCCN says after surgery you should consider adjuvant tx.
What is the preferred tx for advanced stage cervical cancer if they have a positive PDL-1? What defines a positive PDL-1?
Pembrolizumab+Cisplatin/Pactliaxel +/- Bevacizumab. Can also swap Cisplatin with Carboplatin. A CPS greater than or equal to 1 is defined as positive.
If a patient with advanced cervical cancer does not have a positive PDL-1 status, what is the preferred tx?
Cisplatin/Paclitaxel/Bevacizumab (Cat 1 rec), this is preferred over Carboplatin/Paclitaxel/Bevacizumab.
Besides Carbo/Cisplatin and Paclitaxel for advanced cervical cancer, what are some chemo options if their PDL-1 is neg? What to offer if there is a contraindication to Bevacizumab?
Topetecan/Paclitaxel/Bevacizumab. Topetecan/Paclitaxel if there is a contraindication to Bevacizumab. Cisplatin/Topetecan. You can also do Cisplatin or Carbo w/Paclitaxel alone if Bev is contraindicated.
What are the preferred option for metastatic cervical cancer after first line treatment?
Pembro for MSI-H/dMMR or PDL-1 positive tumors. Tisotumab Vedotin. Cemiplimab
What is the mechanism of action of Tisotumab Vedotin and what receptor does it recognize?
It’s an antibody drug conjugate. It contains mono-methyl aurostatin E which binds to tubulin leading to inhibition of polymerization (microtubule). It binds to the tumor factor receptor.
What are some major side effects seen with Tisotumab? What is the survival benefit?
Fatigue, neuropathy, keratitis, dry eyes, and neutropenia. Can get alopecia. Phase 3 study showed that it has a OS and PFS benefit.
What is the tx of Stage IA vulvar cancer, how is this defined?
Stage IA-less 2cm lesion with less than or equal to 1mm of invasion. You treat this with simple partial vulvectomy.
What is tx of Stage IB and select Stage II Vulvar cancer and how is this stage Stage IB defined?
Stage IB is defined as greater than 2cm lesion with more than 1mm invasion. If it’s a lateral lesion you do radical vulvectomy with ipsilateral inguinofemoral lymphadenectomy. Central lesion-bilateral lymph node evaluation. SNLB is also another option if you can’t do lymphadenectomy. Remember after surgery typically need EBRT (if neg margins can hold).
What is the definition of Stage II cervical cancer? What is stage IIB specifically? Remember Stage IB3 or higher can’t get surgery (exception is Stage IIA1)
Carcinoma invades beyond the uterus, but has not extended onto the lower third of the vagina or to the pelvic wall. Stage IIB is parametrial involvement.
What is the preferred treatment for Stage IIA1? This is a higher than stage than IB3 but isn’t treated with chemo/RT
Preferred is Radical hysterectomy w/pelvic lymphadenectomy +/- para aortic node dissection (Cat 2B) or the Cat2B Rec is pelvic EBRT plus brachytherapy +/- concurrent chemo
