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Cervical Cancer Flashcards

1
Q

cervical cancer is the ____ most common gone cancer?

A

3rd

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2
Q

cervical cancer is more common in which races and statuses

A

more common in hispanic and black women and women with low socioeconomic statuses , lower incidence in catholic, mormons and jewish wormen as they have less partners

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3
Q

most common age for cervical cancer

A

20-50y.o.

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4
Q

most common cause for cervical cancer

A

HPV specifically HPV 16 and 18

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5
Q

how long does it take for an HPV infection to become cervical cancer?

A

10-20 years

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6
Q

risk factors for cervical cancer

A

HPV = #1 cause, smoking, oral contraceptives, multiparty, multiparty, herpes virus, multiple sexual partners, estrogen therapy

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7
Q

how long is the cervix

A

2 cm

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8
Q

the cervix connects what?

A

the vagina and uterus

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9
Q

parts of the cervix

A

endocervix- inner part of the cervix made of columnar epithelium
ectocervix-outer part of the cervix made of squamous cells, extends into the vagina
squamo-columnar junction- where the end and ectocervix meet where the squamous epithelium transforms into squamous cell epithelium

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10
Q

lymphatic spread of the cervix

A

usually orderly spread as follows:

Parametrical > pelvic > common iliac > paraortic > sclav (paraortic involvement means a 35% risk of sclav involvement)

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11
Q

distant spread of the cervix

A

lung, bone, liver and brain

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12
Q

most common symptom for cervical cancer

A

is asymptomatic when early, then abnormal vaginal bleeding or discharge is the most common presentation

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13
Q

symptoms of cervical cancer

A

Abnormal vaginal bleeding (most common) or discharge
Discomfort during intercourse
Pelvic/back pain
Odynuria (painful urination)
Hematuria (blood in urine)/hematochezia (blood in stool)

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14
Q

screening for cervical cancer

A

pap smear every 3 years after the age of 21

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15
Q

position for pap smear

A

Pt is in the dorsal lithotomy position (laying supine w/ legs up, knees bent and feet/ankles/calves in stirrups)

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16
Q

when is a colposcopy used?

A

when a patient has a pap smear positive for cervical cancer or for high risk patients

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17
Q

whats a colposcopy?

A

A magnifying microscope is used to visibly examine the cervix for abnormalities
During if any abnormalities are identified a biopsy can be obtained

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18
Q

biopsies used in diagnosing cervical cancer

A

Punch Biopsy: A small piece of tissue is removed using forceps
Endocervical Curettage: Removes tissue from the endocervical canal
Cone Biopsy: A cone shaped piece of tissue from both the ecto and edocervix is removed- used when no tumour is visible but is suspected
Dilatation & Curettage: A procedure which medication is given to the pt to dilate the cervix and allow access to the uterus at which point a curette is used to obtain a biopsy of intrauterine tissue- allows investigation of uterine extansion
Cytoscopy and/or rectosigmoidoscopy: In order to investigate the bladder and lower GI tract

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19
Q

most common pathology of cervical cancer

A

80-90% are SCC

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20
Q

other pathologies of cervical cancer after the most common one?

A

adenocarcinoma and adenosquamous carcinoma

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21
Q

what staging systems are used in staging cervical cancer

A

FIGO and TNM

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22
Q

staging cervical cancer

A

Stage I:
A) Microinvasive disease limited to the cervix
B) Confined to the cervix w/ invasion >5mm deep from the surface or >7mm spread in horizontal direction
Stage II:
A) Extension to vaginal mucosa but not into lower ⅓ of vagina
B) Extension to parametrium but not reaching pelvic side wall
Stage III:
A) Extension to lower ⅓ of vagina
B) Extension to pelvic side wall
Stage IV:
A) Involvement of bladder and rectal mucosa
B) Distant mets

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23
Q

indications for surgery in cervical cancer

A

reserved for early stage cancer

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24
Q

surgical options for cervical cancer

A 
total abdominal hysterectomy
total hysterectomy
subtotal hysterectomy
laser therapy 
cryotherapy 
radical trachelectomy
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25
total abdominal hysterectomy
Removal of the uterus, tubes, ovaries, upper vagina, parametrium and pelvic l/n- used for early stage invasive cancer w/ or w/o a small amount of vaginal involvement
26
total hysterectomy
removal of cervix and uterus
27
subtotal hysterectom
removal of the uterus and not the cervix
28
laser therapy
used for precancerous tumours , a laser eliminates abnormal cells
29
cryotherapy
liquid nitrogen is used for removing abnormal cells used for pre invasive conditions
30
indications for chemotherapy
post-op for high risk early disease | for advanced disease
31
chemo agents used and when
used concurrently with XRT agents are cisplatinum and 5 FU when just cisplatinum is used, there is 5-6 treatments per week, when cisplatinum + 5FU is used there is 2 treatments every 3 weeks
32
indications for XRT:
Post op when 2 or more of the following risk factors are present… Capillary lymphatic space involvement Middle third or greater stromal invasion Tumour =/> 4cm In combo w/ brachy for stage IB and above Palliation
33
Use of prone XRT treatment
Prone: Not typically used but offers advantage of displacing the small bowel anteriorly- especially beneficial for posthysterectomy pts as the small bowel tends to fall into the treatment field
34
preparation for XRT treatment
``` Full Bladder: Stabilize the position of the cervix Reduce amount of small bowel in the field Reduce dose to bladder Empty Rectum: Stabilize the position of the cervix Reduce amount of rectum treated ```
35
planning CT scanning limits
Sup Border – L3/L4 | Inf Border – 5cm inf from ischial tuberosities
36
when is the conventional cervical XRT planning technique used?
Indications: Typically used in a palliative setting | and is a 4 field box with AP/PA field and lats
37
field borders of conventional cervical cancer technique
Sup= L5/S1 or L4/L5 (may be increased to T11/12 if paraortics are involved) Inf= Obturator foramina (may be lower to include entire vagina if involved) Lat= 2cm lat of pelvic brim Ant= Symphysis pubis Post= S2/S3 or 2-3cm post to known extent of disease or to cover 50% of the rectum If the paraortics are involved then there may need to be extended field or the pelvis and the paraortics may have to be treated separately (requiring a gap calc)
38
phases in conventional cervical cancer technique
Phase 1: Treats the entire pelvis to a dose below 20Gy | Phase 2: Boosts the entire parametria an additional 30Gy using a midline shield
39
when is IMRT used in treating cervical cancer?
IMRT is used in all curative cases
40
Treatment margins for intact cervical cancer XRT
CTV= includes entire GTV, cervix, parametria, ovaries and mesoractum of the uterosacral ligaments- if the upper ⅓ of the vagina is involved then the upper ⅔ should be included and if more of the vagina is involved then the entire vagina should be included- l/n should be included in this as well
41
Treatment margins for post hysterectomy XRT
``` CTV= all regions of gross or microscopic disease which would include regional l/n, parametrium and upper half of the vagina PTV= CTV + 7-10mm ```
42
doses of XRT in cervical cancer
``` Typically whole pelvis treated to 40-50Gy/ 20-25 (NECC uses 45Gy/25) w/ brachy to follow 45Gy/25 EBRT AND 28Gy/4 HDR brachy 45Gy/25 amd 30Gy/3 at 1Gy/hr PDR brachy 50Gy/25 EBRT and 24Gy/4 HDR brachy 50.4Gy/28 EBRT and 28Gy/4 HDR brachy ```
43
treatment of stage 1A cervical cancer
Conization may be a suitable treatment for lesions <1mm provided all margins are negative and careful follow-up is performed Larger lesions may be treated with total abdominal/modified radical hysterectomy/trachelectomy or intracavitary brachy (EBRT usually not needed in addition to brachy if the lesion <1cm) Intracavitary doses would be 60 to 75 Gy, in two LDR insertions or with the equivalent dose using HDR brachytherapy, approximately 10 fractions of 5 Gy per fraction When the depth of penetration by tumor is <3 mm, the incidence of lymph node metastasis is 1% or less and a lymph node dissection or pelvic external irradiation is not warranted
44
treatment of stage 1B-2A cervical cancer
Typically treated w/ total abdominal hysterectomy and pelvic lymphadenectomy May receive post op chemoradiation
45
treatment of stage 2b-4a cervical cancer
Typically receives concurrent chemoradiation EBRT to 45Gy/25 w/ possible brachy and five to six weekly doses of cisplatin or two doses of cisplatin and 5-FU every 3 weeks
46
treatment of stage 4b cervical cancer
Treated palliatively which may include XRT to relieve pain or to stop bleeding
47
most important prognostic indicator in cervical cancer.. what are the other factors?
``` Stage is the most influential Other factors include… Age- younger is worse Race L/N involvement LVI Histopathology- squamous better than adenocarcinoma ```
48
what are the 2 main treatment options for stage 1b-2a v
XRT or SX
49
What is the best treatment option for a stage IB pt who is 25y.o. and would like to start having children
Surgery is preferential | if pt needs XRT she should have an ovarian transposition
50
what is the problem with ovarian transpositions when it comes to fertility
pt can maintain fertility however they will not be able to have the child without a surrogatee as this procedure require the detachment of fallopian tubes and ovaries from the uterus and cannot be reattached
51
CT scanning limits
L3-L4 to 5 cm ind of ischial tuberosities
52
stage 1a treatment options
1) surgery (radical trachelectomy ) for its who want children or extrafascial hysterectomy 2) Brachy 50/10 for HDR or 60-75/2 LDR
53
IF A PT has a stage 1B-2A bulky disease, what extra treatment ill they get?
a weekly dose of crisp;actinium
54
stage 1b-2a treatment if children are wanted post therapy
if pt wants children- sx id + margins, LN then they will also get XRT- EBRT-45/25 + 15Gy LDR or 11/2 HDR
55
Stage 1B-2A treatment for 60y.o. pt
Pt is no longer at child bearing age therefore preservation of ovaries is not necessary- they will receive XRT 45//25 +GDR brachy 28/4
56
LN drainage
Parametrical-pelvic-common iliac-paraortic- supraclavicular
57
what LN are most commonly involved in cervical cancer | N.B. not the same as the route of drainage
pelvic and common iliac are most common
58
General treatments for stage 2B-4A
chemorads
59
Treatment 4B disease
palliative chemo cisplatinum + ifosfamide palliative EBRT for gene bleeding - ferric sulphate + palliative EBRT 3-4Gy x 3-5Fx
60
what is th out common side effect from XRT
anemia- 12-16g/dl hemoglobin levels are normal, below indicates anemia
61
when PA ln are + there is a 35% risk of spread of what?
supreclavicular LN
62
pt finishes XRT and experiences abdominal distention and hyperactive bowel sounds... what could this indicate?
bowel obstruction

Skin Radiation therapy (40 decks)

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