Cervical Cancer Management Options

Question 1

Management of Stage IA1

Answer 1

• Stromal invasion <3mm
  Options are: Knife cone biopsy, LLETZ/NETZ (loop or needle excision of transformation zone), Total hytsterectomy, Radical hysterectomy

Question 2

Cochrane Review (2019)

Answer 2

• Nerve sparing hysterectomy (total) could improve bladder control after surgery but there is concern that it could impact outcomes in term of survival

Question 3

Surgical Complications

Answer 3

Surgical Complications: Death, Bladder injury (0-10%), Bowel Injury (1-2%), Ureteric Injury (0-6%), Vesicovagino fistula (0-2%), Sexual Dysfunction, Lymphodoema, Pelvic Cysts

Question 4

Management of Stage IA2 and IIB1

Answer 4

• IA2 (>3mm invasion) IIB1 (parametrial involvement, not into pelvic walls, <4cm)
• Chemoradiotherapy - may have higher incidence of long term morbidity
• Surgery (radical hysterectomy) - preferred for younger patients as it maintains ovarian function
• If fertility is necessary, radical trachelectomy with pelvic node resection. - Tumour must be <2cm

5 Year survival = 95-98%, is surgery necessary

Question 5

Management of Stage IB2, IIA+B, IIIA,B+C

Answer 5

• IB2 = >4cm
• IIA+B = Beyond cervix, 2/3 of vagina + parametrium
• IIIA+B+C = Extension to pelvic side wall/ lower 3rd of vagina, paraaortic or pelvic nodal involvement
• Chemo/RT = gold standard. EBRT with Cisplatin. Target the whole pelvis and lymph node chains to bifunction of the aorta. 45-50Gy in 5 weeks. Followed by Brachy, 25 -30Gy to cervix and surrounding tissues (if not, then EBRT boost).
• Surgery. After chemo/RT if incomplete remission. After Chemo/RT if used to shrink tumour (normal margins). In countries where RT unavailable, after chemo.

Question 6

Chemotherapy

Answer 6

• Cistplatin: 40mg/m3 over 40mins
• ## If cis or carboplatin unavailable usually not used at all (cochrane says maybe use others but more research needed).

Question 7

Management of Advanced Disease

Answer 7

• Stage IVA = Spread to adjacent tissues
• Chemo/RT for local control (Hoskin says Chemo has limited impact)
• Chemo regimens = Paclitaxel, Carboplatin, Bevacizuman or Cisplatin and Toptecan
• Stage IVB = Spread to distant organs
• Cisplatin and toptecan (if not already had cisplatin)
• Pelvic Radiation for local control
• Pelvic Exteneration (multiple organ removal

Question 8

Recurrent Disease

Answer 8

• Causes pelvic, back and buttock pain, bowel disturbance and leg odoema
• Treatment is dependent on previous treatments, site of recurrence and interval disease free
• If confined to the pelvis and no previous RT/Chemo, RT = curative 40-50%
• Pelvic exeneration not suitable if disease is present on the pelvic wall. 1/3 of operations are abandoned.
• Palliative Chemo
• VEGF

Question 9

Nephrostomy

Answer 9

• If ureter is damaged, tube from kidneys out of body

- Urine collected in a bag