Cervical Cancer Flashcards
Incidence
7:100000
Mortality rate
50%
Risk factors for cerv cancer
Smokin Immunosuppression Age - bimodal Parity Partners OCP use (not an independent risk factor) DES exposure HPV exposure - essential requirement Inadequate screening
How to stage cervical cancer
Pre op MRI or EUA & cystoscopy
FIGO says: Cool EUA Endocervical curettage Hysteroscopy Cystoscopy Proctoscopy IV urography XRay of lungs and skeleton
FIgo stage 1 cerv ca
Cancer confined to the cervix
IA:dx only by microscopy; stromal invasion with a max depth of 5.0mm and largest extension of < or =7mm
Ia1: measured stromal invasion <3.0mm
1A2: measured stromal invasion > or = 3 and <5mm
Figo stage IB
Clinically visible lesion confined to the cervix or microscopic lesion greater than T1a/IA2 (depth > or =5mm)
IB1: < or =4
IB2: >4cm, clinically visible
Figo stage 2 (a-B)
Cancer invades beyond uterus but not to pelvic wall or to lower third of vagina
IIA: no parametrial invasion
IIA1: clinically visible lesion < or =4cm
IIA2: clinically visible lesion >4cm
IIB: tumour with parametrial invasion
Stage III
Tumor extends to pelvic wall and/or involves lower third of vagina and or causes hydronephrosis or nonfunctional kidney
IIIA: tumor involves lower third of vagina, no extension to pelvic wall
IIIB: Tumor extend to pelvic wall or affects kidney
IIIB pelvic and para-aortic nodes
Figo stage 4
Tumour invades mucosa of bladder or rectum and or extends beyond true pelvis
IVA: local spread (bladed, rectum)
IVB: spread beyond pelvis
Treatment for stage 1AI
Can be treated conservatively with cone biopsy or LLETZ
LN risk <1.5%
Radical hysterectomy
Resection distant from edge of cervix
Uterine arteries are divided at the source
Vaginal cuff 1-2cm
Lymphadenectomy (not always)
Treatment for figo stage IB2 and IIa1
Surgery or RT
Both have similar outcomes
Treatment for 1B3 and IIA2
Radical hysterectomy with lymphadenectomy
Concurrent platinum-based chemoradiation (prognosis more favorable)
FIGO stage IIB to IVA or recurrence treatment
RT with chemo OR
Exteneration in medically fit patients
Treatment stage IVB/distant Mets
Chemoradiation
Cisplatin
Median time to recurrence
7-36 months
Follow up
Every 3-4 months for the first 2-3 years
6 monthly until 5 years
Annual for life
Pelvic lymphadenectomy
Parametrial nodes
Obturator nodes
Internal, external, and common iliac nodes
Paraaortic node dissection
Resection of nodal tissue over the distal IVC from the level of the inferior mesenteric artery to the mid R common iiiac artery and b/w the aorta and left ureter from the inferior mesenteric after to the L mid common iliac artery
Oncogenes
E5,6,7
Cells infected by HPV
Parabasal cells
Koliocytes presence
HPV infected cells
Percentage of HPV infections that spontaneously resolve
80%
How HPV infects
Genome integrates into host genome
E6 & E7 proteins over-expressed
P53 and PRB inactivated
Arrest of cell division PREVENTED
