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Year 5: Gynaecology > Cervical cancer (Complete) > Flashcards

Cervical cancer (Complete) Flashcards

1
Q

Define cervical cancer

A

Type of cancer that occurs in the cells of the cervix, the lower part of the uterus that connects to the vagina.

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2
Q

What is the clinical burden of cervical cancer?

A

3rd most common cause of cancer

4th most common cause of cancer related death

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3
Q

Cervical cancer is associated with what virus?

A

Human papilloma virus (HPV)

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4
Q

What HPV serotypes are most commonly associated with cervical cancer?

A

16

18

33

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5
Q

What type of cervical cancer is most commonly seen?

A

Squamous cell cervical cancer (80%)

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6
Q

What is the less commonly seen type of cervical cancer?

A

Adenocarcinoma

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7
Q

What are the main risk factors for cervical cancer?

A

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*

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8
Q

Cervical cancer commonly affects which age groups?

A

Under 45s:

25-29 years

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9
Q

What are the main signs/symptoms of cervical cancer?

A

Symptoms:

Vaginal discharge and discomfort: Foul smelling and sometimes with 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

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10
Q

What differential diganoses should be considered alongside cervical cancer?

A

Red-flags:

Endometrial cancer

Others:

Cervical polyps

Vaginitis

Cervicitis

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11
Q

How does cervical cancer differ to vaginitis?

A

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

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12
Q

How does cervical cancer differ to endometrial cancer?

A

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.

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13
Q

How does cervical cancer differ to cervicitis?

A

Duration and Persistence: Symptoms of cervical cancer tend to be persistent and worsen over time, while cervicitis symptoms may come and go

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14
Q

How does cervical cancer differ to cervical polyps?

A

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.

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15
Q

What examination/investigations should be considered in patients suspected of having cervical cancer?

A

Bedside:
Speculum examination:

PR exam: Check for masses

Basic obs: Check for weight loss

Imaging:

Urgent colposcopy

CT chest/abdomen/pelvis: Used for cancer staging

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16
Q

What is the first-line investigation for cervical cancer?

A

Colposcopy

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17
Q

What signs on speculum examination are suggestive of cervical cancer?

A

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

18
Q

What staging system is used for cervical cancer?

A

FIGO staging

19
Q

Name the stages in FIGO for cervical cancer

A

IA

IB

II

III

IV

20
Q

What is considered FIGO stage IA?

A

Confined to cervix, only visible by microscopy and less than 7 mm wide

A1: < 3 mm deep

A2: 3-5 mm deep

21
Q

What is the management for Stage IA cervical cancer?

A

Gold-standard: Hysterectomy +/- lymph node clearance

Nodal clearance for A2

Close monitoring

22
Q

How does stage IA1 and IA2 management differ?

A

Both require hysterectomy

A2 additonally requires lymph node clearance

23
Q

For patients with stage IA1 cervical cancer and want to maintain fertility, what alternative management is available?

A

Cone biopsy with negative margins can be performed

24
Q

For patients with stage IA2 cervical cancer and want to maintain fertility, what alternative management is available?

A

Radical trachelectomy

25
Q

What is considered FIGO stage IB?

A

Confined to cervix, clinically visible or larger than 7 mm wide:

B1: < 4 cm diameter

B2: > 4 cm diameter

26
Q

What is the management for Stage IB1 cervical cancer

A

Radiotherapy with concurrent chemotherapy (Cisplatin)

(CCRT: Concruent chemoradiotherapy)

27
Q

What is the management for Stage IB2 cervical cancer

A

Radical hysterectomy with pelvic lymph node dissection

28
Q

What is considered FIGO stage II?

A

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)

29
Q

What is considered FIGO Stage III?

A

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

30
Q

What tumor presentation results in automatic III staging?

A

Tumor causing hydronephrosis or non-functioning kidney

31
Q

How is stage II and III cerivcal cancer managed?

A

Radiotherapy with concurrent chemotherapy

Nephrostomy: If hydronephrosis occurs

32
Q

How should patients with hydropnephrosis secondary to cervical cancer be managed?

A

Nephrostomy

33
Q

What is considered FIGO stage IV cervical cancer?

A

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

34
Q

How is stage IV cervical cancer managed?

A

Radiation and/or chemotherapy

Palliative chemotherapy: may be best option for stage IVB

35
Q

What type of chemotherapy is used for cervical cancer?

A

Cisplatin

36
Q

What type of radiotherapy is used for cervical cancer management?

A

Bachytherapy

External beam radiotherapy

37
Q

What is the five year prognosis for cervical cancer per stage?

A

I: 95%

II: 54%

III: 38%

IV: 5%

38
Q

What are some complications of cone biopsies and radical trachelectomy?

A

Increase risk of preterm birth in future pregnancies

39
Q

What complication can arise from radical hysterectomy?

A

Ureteral fistula

40
Q

What are some short-term complications of radiotherapy in treatment of cervical cancer?

A

Diarrhoea

Vaginal bleeding

Radiation burns

Pain on micturition

Tiredness/weakness

41
Q

What are some long-term complications of radiotherapy in treatment of cervical cancer?

A

Ovarian failure

Fibrosis of bowel/skin/bladder/vagina

Lymphoedema

Year 5: Gynaecology (14 decks)

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