Cervical cancer (Complete) Flashcards
Define cervical cancer
Type of cancer that occurs in the cells of the cervix, the lower part of the uterus that connects to the vagina.
What is the clinical burden of cervical cancer?
3rd most common cause of cancer
4th most common cause of cancer related death
Cervical cancer is associated with what virus?
Human papilloma virus (HPV)
What HPV serotypes are most commonly associated with cervical cancer?
16
18
33
What type of cervical cancer is most commonly seen?
Squamous cell cervical cancer (80%)
What is the less commonly seen type of cervical cancer?
Adenocarcinoma
What are the main risk factors for cervical cancer?
Human papillomavirus (HPV)
Smoking (impaired immune system and carcinogenic effects)
Human immunodeficiency virus (HIV)
Early first intercourse (increased exposure, lower immune system in adolescent, delayed screening and diagnosis)
Many sexual partners
High parity
Lower socioeconomic status
Combined oral contraceptive pill
Cervical cancer commonly affects which age groups?
Under 45s:
25-29 years
What are the main signs/symptoms of cervical cancer?
Symptoms:
Vaginal discharge and discomfort
* Foul smelling
* Occasional blood
Post-coital, intermenstrual or post-menstrual bleeding
Bleeding with mictruration or defecation
Urinary or bowel habit change
* Bladder and rectal compression due to tumor
Suprapubic pain
* Bladder/uterine compression/inflammation
Signs:
Abnormal white/red patches on the cervix
Pelvic bulkiness on PV examination
Mass felt on PR examination
What differential diganoses should be considered alongside cervical cancer?
Red-flags:
Endometrial cancer
Others:
Cervical polyps
Vaginitis
Cervicitis
How does cervical cancer differ to vaginitis?
Bleeding Pattern: vaginitis typically does not cause bleeding.
Pelvic Pain: Dull aching suprapubic pain is more commonly associated with cervical cancer, whereas vaginitis tends to cause localized vaginal discomfort.
Systemic Symptoms: Cervical cancer may be associated with systemic symptoms
How does cervical cancer differ to endometrial cancer?
Age: Cervical cancer more likely to affect under 45 whereas endometrial more commonly seen post-menopause
Bleeding Patterns: Cervical cancer is often associated with postcoital bleeding bleeding, while endometrial cancer typically presents with postmenopausal bleeding or abnormal menstrual bleeding.
Vaginal Discharge: More commonly associated with cervical cancer.
Location of Pain: Pelvic pain in cervical cancer may be more focused on suprapubic, while endometrial cancer may be more diffuse and related to the uterus.
Urinary and Bowel Symptoms: more associated with advanced cervical cancer due to local invasion into nearby organs.
Ascites: more commonly associated with advanced endometrial cancer.
How does cervical cancer differ to cervicitis?
Duration and Persistence: Symptoms of cervical cancer tend to be persistent and worsen over time, while cervicitis symptoms may come and go
How does cervical cancer differ to cervical polyps?
Bleeding Characteristics: Cervical cancer presents with heavier and more prolonged bleeding versus intermittent lighter bleeds associated with cervical polyps
Systemic symptoms: Cervical cancer is more likely to be associated with systemic symptoms
Pelvic Pain: Cervical cancer pain tends to be more persistent and severe compared to the mild discomfort or cramping associated with cervical polyps.
What examination/investigations should be considered in patients suspected of having cervical cancer?
Bedside:
Speculum examination:
PR exam: Check for masses
Basic obs: Check for weight loss
Vaginal swab: check for STD
Bloods:
FBC: Check for anamia
U&Es: Check renal function (hydronephrosis can occur with large masses)
Imaging:
Urgent colposcopy
CT chest/abdomen/pelvis: Used for cancer staging
What is the first-line investigation for cervical cancer?
Colposcopy
What signs on speculum examination are suggestive of cervical cancer?
Nodular and assymetric cervix
Fixed/indurated mass on cervix
Dark or discouloured areas
Persisent erosion: Normal occurence but if persistent may warrant further investigation
Ulcerative lesions
Foul smelling discharge
Friability
What staging system is used for cervical cancer?
FIGO staging
Name the stages in FIGO for cervical cancer
IA
IB
II
III
IV
What is considered FIGO stage IA?
Confined to cervix, only visible by microscopy and less than 7 mm wide
A1: < 3 mm deep
A2: 3-5 mm deep
What is the management for Stage IA cervical cancer?
Gold-standard: Hysterectomy +/- lymph node clearance
Nodal clearance for A2
Close monitoring
How does stage IA1 and IA2 management differ?
Both require hysterectomy
A2 additonally requires lymph node clearance
For patients with stage IA1 cervical cancer and want to maintain fertility, what alternative management is available?
Cone biopsy with negative margins can be performed
For patients with stage IA2 cervical cancer and want to maintain fertility, what alternative management is available?
Radical trachelectomy
What is considered FIGO stage IB?
Confined to cervix, clinically visible or larger than 7 mm wide:
B1: < 4 cm diameter
B2: > 4 cm diameter
What is the management for Stage IB1 cervical cancer
Radiotherapy with concurrent chemotherapy (Cisplatin)
(CCRT: Concruent chemoradiotherapy)
What is the management for Stage IB2 cervical cancer
Radical hysterectomy with pelvic lymph node dissection
What is considered FIGO stage II?
Extension of tumour beyond cervix but not to the pelvic wall
A: upper two thirds of vagina
B: parametrial involvement (past cervix’s outer smooth muscle)
What is considered FIGO Stage III?
Extension of tumour beyond the cervix and to the pelvic wall
A = lower third of vagina
B = pelvic side wall
Any tumour causing hydronephrosis or a non-functioning kidney is considered stage III
What tumor presentation results in automatic III staging?
Tumor causing hydronephrosis or non-functioning kidney
How is stage II and III cerivcal cancer managed?
Radiotherapy with concurrent chemotherapy
Nephrostomy: If hydronephrosis occurs
How should patients with hydropnephrosis secondary to cervical cancer be managed?
Nephrostomy
What is considered FIGO stage IV cervical cancer?
Extension of tumour beyond the pelvis or involvement of bladder or rectum:
A: involvement of bladder or rectum
B: involvement of distant sites outside the pelvis
How is stage IV cervical cancer managed?
Radiation and/or chemotherapy
Palliative chemotherapy: may be best option for stage IVB
What type of chemotherapy is used for cervical cancer?
Cisplatin
What type of radiotherapy is used for cervical cancer management?
Bachytherapy
External beam radiotherapy
What is the five year prognosis for cervical cancer per stage?
I: 95%
II: 54%
III: 38%
IV: 5%
What are some complications of cone biopsies and radical trachelectomy?
Increase risk of preterm birth in future pregnancies
What complication can arise from radical hysterectomy?
Ureteral fistula
What are some short-term complications of radiotherapy in treatment of cervical cancer?
Diarrhoea
Vaginal bleeding
Radiation burns
Pain on micturition
Tiredness/weakness
What are some long-term complications of radiotherapy in treatment of cervical cancer?
Ovarian failure
Fibrosis of bowel/skin/bladder/vagina
Lymphoedema
