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FRCR CO2A > Cervical Cancer > Flashcards

Cervical Cancer Flashcards

1
Q

What’s the mc cause of death from female pregnancy worldwide?

A

Cervical Cancer

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2
Q

What’s the major RF a/w cervical cancer?

A

HPV 16 and 18

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3
Q

What are the lateral structures of cervix?

A

Parametria lie within the broad ligaments and contain ureters (1-2 cm) from the cervix and uterine arteries

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4
Q

Which viral proteins are responsible for malignant transformation?

A

E6 and E7

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5
Q

which virus may act as co factor ?

A

HSV type 2

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6
Q

What are the RFs which increases chances of exposure to HPV?

A
  1. early onset of sexual activity
  2. early age at 1st pregnancy
  3. multiparity
  4. multiple sexual partners
  5. smoking and low social class
  6. smoking and immunocompromised states
  7. DES: exposure in utero: clear cell carcinoma as in vagina
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7
Q

what’s the standard screening technique in England and wales

A

Liquid Based Cytology

replaced Papanicolau smear

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8
Q

How does screening guide further managment?

A

Normal: repeat in 3 to 5 years

Inadequate: repeat

Borderline : refer for colposcopy within 4 weeks

CIN1 to CIN 3: Colposcopy

Possible invasion and Glandular invasion: Colposcopy within 2 weeks

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9
Q

who can avoid colposcopy following Cervical Screening?

A

HPV test negative

HPV +: immediate colposcopy

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10
Q

How can Cervical Cancer be prevented?

A

Quadrivalent Vaccine (HPV 6, 11, 16 and 18)

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11
Q

Does vaccination obviate the need for screening? and WHy?

A

No

other viruses can cause

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12
Q

How long does it take from CIN to Invasive cancer?

A

10 to 12 years

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13
Q

About what % of pts with CIN 3 develop Invasive carcinoma?

A

30%

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14
Q

On IHC, how are sq cell carcinoma and Adenocarcinoma differentiated?

A

Reactivity to anti cytokeratin: epithelial origin

ab against mucin: Adenocarcinoma

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15
Q

How to distinguish between endocervical and endometrial adenocarcinoma?

A

Endocervical: CEA +, P16 +, HPV +

Endometrial tumors: vimentin +, ER +, PgR +

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16
Q

What are s/s of cervical cancer?

A
  1. Abnormal VAgina bleeding
  2. Vaginal discharge
  3. Dyspareunia
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17
Q

What does abnormal vaginal bleeding mean?

A

Post coital
intermenstrual
post menopausal
heavy menstrual bleeding with pain/pressure symptoms

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18
Q

what are the clinical features of local spread of cervical cancer?

A
  1. Renal failure due to ureteric obstn
  2. frequency and dysuria
  3. pelvic pain
  4. bladder outflow obstruction
  5. change in bowel habbit
  6. rectal bleeding
  7. hematuria
  8. urine incontinence (vvf)
  9. faecal incontinence
  10. deep pelvic pain and lymphedema of legs
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19
Q

How is parametrial invasion best examined?

A

PR

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20
Q

What are staging Investigations for cervical cancer?

A
  1. Cervical Biopsy
  2. MRI for primary tumor assessment
  3. CT Chest
  4. PET CT for locally advanced cervical caner amenable to CRT
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21
Q

What test should not be missed in premenopausal women ?

A

Pregnancy test

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22
Q

What’s the Rx of St IA1 cervical cancer?

A

Simple Hysterectomy is adequate

Post menopausal : Hysterectomy + BSO

Fertility sparing: Knife cone biopsy

23
Q

What’s the Rx of St IA2 cervical cancer?

A

LN risk: 7.4 %
Mod Rad Hysterectomy and LND

Fertility sparing: RAdical tracheloectomy

Medically unfit or pt who decline: RT RAdical

24
Q

What’s the Rx of St IB1 and small volume st IIA cervical cancer?

A

Surgery or RT

25
Which structures are removed in radical Wertheim hysterectomy?
Uterus, upper third vagina and entire parametrium and B/L Lymphadenectomy Preserve ovary if premenopausal Fertility sparing: Radical Vaginal Trachelectomy and laparoscopic Lymphadenectomy
26
What's the Rx of St IB2 to IVA cervical cancer?
CRT followed by Brachy No conc chemo for unfit pts
27
What's the Rx of St IVB cervical cancer?
Palliative Rx (chemo, RT, and surgery)
28
What's the Rx for recurrent cervical cancer?
Central Pelvic Recurrence: following CRT: Surgery isolated mets as regional LN: SBRT
29
What are the four level defined by RCR for IGBT?
1. verification of applicator position 2. accurate definition of OAR doses 3. Conformation of dose distribution 4. Dose escalation
30
What should be the minimum equivalent (2 Gy/#) to HRCTV?
75 to 80 Gy
31
What should be included in HRCTV?
All residual macroscopic tumor, whole cervix and presumed extracervical tumor (grey zones on MRI)
32
what tolerances are taken for rectum, sigmoid/bowel and Bladder?
alpha/beta: 3, rectum 70 to 75 Gy Sigmoid/bowel 70 to 75 Gy Bladder 90 - 95 Gy
33
what are advantages of HDR BT over LDR BT?
1. patient convenience 2. reduced treatment time 3. radiation protection and machine availability
34
what's current recommended dose for EBRT in UK for cervical cancer?
45 Gy/ 25# 50.4 Gy/ 28#
35
what's the BT dose?
21 Gy/ 3 sessions others; 14 Gy/ 2 sessions
36
what are conventional field borders for Cervical CAncer RT ?
As in Endometrial cancer
37
How is image verification done for RT ?
1st 3 days CBCT or portal beam and then weekly
38
What chemo, at what dose and when should be given with RT
Cisplatin 40 mg/m2 weekly , 1 hour prior to RT
39
when should cisplatin not be given?
poor renal function or poor PS
40
what is definition of pt A ?
Manchester system 2 cm above the lateral vaginal fornixes and 2 cm lateral to central uterine tube
41
what is pt B?
5 cm lateral to midline
42
what is ICRU 38 bladder point?
posterior surface of bladder balloon
43
What is rectal point?
5 mm behind the postr vaginal wall at the level of lower end of the intrauterine source
44
What are the indications of adjuvant CRT in cervical cancer?
1. positive LN 2. Positive margin 3. positive parametria
45
what are the systemic treatment options for Cervical Cancer? (NCCN 2025)
* PD-L1–positive tumors Pembrolizumab + cisplatin/paclitaxel ± bevacizumab (category 1)e,f,i,7 Pembrolizumab + carboplatin/paclitaxel ± bevacizumab (category 1)e,f,i,7 * Cisplatin/paclitaxel/bevacizumabe,8 (category 1) * Carboplatin/paclitaxel/bevacizumabe * Atezolizumab + cisplatin/paclitaxel + bevacizumab (category 1) * Atezolizumab + carboplatin/paclitaxel + bevacizumab (category 1)e,
46
what are Concurrent Chemo recommendation as per NCCN (2025)?
Cisplatin + pembrolizumab category 1: FIGO 2014 Stage IIIA, IIIB, and IVA category 2B: select FIGO 2018 stage III–IVA * Carboplatin + pembrolizumab if cisplatin intolerant category 1: FIGO 2014 Stage IIIA, IIIB, and IVA category 2B: select FIGO 2018 stage III–IVA * Cisplatin * Carboplatin if cisplatin intolerant
47
How to manage Cervical cancer during pregnancy?
1st and 2nd trimester: termination of pregnancy followed by Rx 3rd : Wait for Birth: CS and Hysterectomy
48
How is SCLC cervix treated?
Chemo as in SCLC followed by RT Surgery for few pts with small volume
49
what are the prognostic factors for cervical cancer?
Tumor Related Patient Related Treatment related
50
what are the tumor related prognostic factors for cervical cancer?
1. increased tumor bulk 2. LN + 3. LVSI + 4. higher stages 5. Adenocarcinoma
51
what are the Patient related prognostic factors for cervical cancer?
1. anemia 2. smoking 3. PS poor
52
what are the treatment prognostic factors for cervical cancer?
1. + margin 2. long duration of RT treatment 3. no ICBT
53
What are approx 5 yrs survival for Cervical cancer pts, stage wise?
IA: 100 % IB: 80 to 95 % II: 60 to 90 % III: 30 to 50 % IV: 5 to 20 %

FRCR CO2A (35 decks)

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