Cervical Cancer Flashcards
Cervical cancer is the ___ most common type of gyn cancer
third
What is the average length of time from a normal pap to cervical cancer?
10 years
what percentage of invasive cervical cancers are visible lesions (stage 2)
50%
What is the most common type of cervical cancer?
Squamous cell adenocarcinoma (90%)
What is the second most common type of cervical cancer?
Adenocarcinoma 15 - 20%
What tests/procedures should be done to completely stage a patient with cervical cancer?
EUA, Cystoscopy, proctoscopy, CXR, IV pyelogram
What imaging modality should you use to evaluate for concerning nodal metastasis in a patient with cervical cancer?
PET- CT
What imaging modality should you use to evaluate for local recurrence, size of lesion or extend of local invasion?
MRI
Criteria for conservative management of cervical cancer (CKC or observation)
- desired fertility
- Stage IA1 disease (< 3mm depth of invasion)
- negative conization margins
- no LVSI
- No small cell or neuroendocrine histology
Management of IA1 cervical cancer
Conization or extrafascial hysterectomy
Management of stage 1 A2 cervical cancer
Modified radical hysterectomy + Lymph node dissection
Management of stage IB1- IB2 cervical cancer
Radical hysterectomy + RT
Management of stage IB3 cervical cancer
ChemoRT + Brachytherapy
Management of stage II - Stage IV cervical cancer
ChemoRT + Brachytherapy
What are the components of a radical hysterectomy?
- Removal of parametria, upper vagina and lymphnodes
- Dissection of the ureters to the bladder
- Dissection of rectum off of posterior vagina
- Ligation of uterine arteries at their origin
True or false: Disease Free survival at 4.5 years for a minimally invasive hysterectomy for cervical cancer was inferior to an open approach
True
Indications for primary radiotherapy in the treatment of cervical cancer?
Stage IB3
tumor size > 4 cm
LVSI
stromal invasion
Indications for primary radiotherapy AND chemosensitization?
Stage Stage IIB and up
parametrial involvement
positive lymph nodes
positive surgical margins
External beam radiation: Total dose of radiation
5000 - 6000 rads
External beam radiation: How many weeks of treatment?
5-6 weeks
External beam radiation: How many days per week of treatment?
5 days per week
External beam radiation: How much radiation treatment per dose
180 rads
Follow up for Cervical Cancer
Pap smear and exam
Every 3 months for 2 years.
Every 6 months for 3 years.
Yearly after 5 years.
How do you treat recurrent cervical cancer after previous hysterectomy? (Central recurrence)
Radiation therapy
How do you treat recurrent cervical cancer after previous radiation therapy ? ( Central recurrence)
Pelvic Exenteration
How do you treat recurrent cervical cancer that has distant recurrence or recurrence at the pelvic side wall?
Chemotherapy: Taxol/Cisplatin + Bevacizumab
How do you treat cervical cancer in pregnancy if < 24 wga and undesired pregnancy?
Treat as non pregnant
How do you treat cervical cancer if < 24 weeks, desired or > 24 weeks undesired with CIS/Microinvasion
Vaginal delivery
How do you treat cervical cancer if < 24 weeks, desired or > 24 weeks undesired with stage IA2 - IB disease < 2 cm
CKC or trachelectomy
How do you treat cervical cancer if < 22 weeks, desired or > 22 weeks undesired with stage IB disease > 2 cm
Neoadjuvant chemotherapy followed by CS and radical hysterectomy for stage I disease
Neoadjuvant chemotherapy and chemo + RT for stage II - IV disease
