Cervical Cancer Flashcards

1
Q

What are some of the main risk factors seen with Cervical Cancer?

A

HPV (high risk types: 16 and 18), immunosuppression, HIV, smoking, early coitus, high risk sexual partner.

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2
Q

For stage I cervical cancer how is this primarily treated?

A

In general the tx strategy is surgery +/- RT depending on if they have high risk pathologic features.

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3
Q

What are the high risk features should be absent if the patient desires fertility preservation?

A

Tumor>2cm, LVI, lymph node involvement, endocervical extension

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3
Q

What are the high risk features that would determine for Stage IA/IB/IA2-IB2 that patients need adjuvant therapy?

A

Positive surgical margins, positive pelvic or para-aortic nodes, extension to the parametria.GW slide mentioned deep cervical stromal invasion

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4
Q

In general, what are the options for early stage (Stage IA1-2, IB1 and IB2) who desire fertility preservation?

A

Cone biopsy with negative margins + pelvic lymphadenectomy or radical trachelectomy+ pelvic lymphadenectomy

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5
Q

For Stage IA1-2 with LVSI what are the treatment options?

A

You can do a radical hysterectomy with pelvic lymphadenectomy or EBRT w/vaginal brachytherapy.

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6
Q

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?

A

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.

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7
Q

What adjuvant tx is given for those patients with early stage cervical cancer after surgery w/high risk features?

A

EBRT with Cisplatin +/- Vaginal brachytherapy

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8
Q

When a patient has a localized distant metastatic recurrence what can be offered?

A

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.

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9
Q

What is the preferred tx for advanced stage cervical cancer if they have a positive PDL-1? What defines a positive PDL-1?

A

Pembrolizumab+Cisplatin/Pactliaxel +/- Bevacizumab. Can also swap Cisplatin with Carboplatin. A CPS greater than or equal to 1 is defined as positive.

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10
Q

If a patient with advanced cervical cancer does not have a positive PDL-1 status, what is the preferred tx?

A

Cisplatin/Paclitaxel/Bevacizumab (Cat 1 rec), this is preferred over Carboplatin/Paclitaxel/Bevacizumab.

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11
Q

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?

A

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.

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12
Q

What are the preferred option for metastatic cervical cancer after first line treatment?

A

Pembro for MSI-H/dMMR or PDL-1 positive tumors. Tisotumab Vedotin. Cemiplimab

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13
Q

What is the mechanism of action of Tisotumab Vedotin and what receptor does it recognize?

A

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.

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14
Q

What are some major side effects seen with Tisotumab? What is the survival benefit?

A

Fatigue, neuropathy, keratitis, dry eyes, and neutropenia. Can get alopecia. Phase 3 study showed that it has a OS and PFS benefit.

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15
Q

What is the tx of Stage IA vulvar cancer, how is this defined?

A

Stage IA-less 2cm lesion with less than or equal to 1mm of invasion. You treat this with simple partial vulvectomy.

16
Q

What is tx of Stage IB and select Stage II Vulvar cancer and how is this stage Stage IB defined?

A

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).

17
Q

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)

A

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.

18
Q

What is the preferred treatment for Stage IIA1? This is a higher than stage than IB3 but isn’t treated with chemo/RT

A

Preferred is Radical hysterectomy w/pelvic lymphadenectomy +/- para aortic node dissection (Cat 2B) or the Cat2B Rec is pelvic EBRT plus brachytherapy +/- concurrent chemo