Cervical Cancer OXCOG podcast Flashcards

1
Q

UK Stats for cervical cancer
Cases per year in UK
Case per 100

A

3200 in UK
3rd most common gynae cancer in developed (Endometrial, Ovarian)
lifetime risk of developing cervical 7 in 1000 women UK

In developing countries 2nd most common cancer, 3rd most common cancer death (most common gnar cancer worldwide)

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2
Q

HPV is detected in what % cervical cancers?

A

99.7%

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3
Q

What are the most common types of cervical cancer?

A

Squamous Cell carcinoma 70%
Adenocarcinoma 25%

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4
Q

RF cervical cancer

A

HPV related
- Early onset sexual activity
- Multiple sexual partners
- High risk sexual partner
- Hx STIs
- immunosupression

Non HPV related
- Low socioeconomic status
- COCP > 5years, background after 10 years
- Cigarette smoking - squamous cell not adenocarcinoma
- Genetics

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5
Q

How many HPV are oncogenic

A

15 of the 40 HPV
HPV 16&18 in 70% of cervical cancers

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6
Q

How many sexual active patient have HPV at some point

A

75-85%, most people clear the virus

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7
Q

Squamous cell carcinoma - HPV subtypes

A

16 60%
18 13%
58/33 5%

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8
Q

Adenocarcioma cell carcinoma - HPV

A

16 36%
18 37%
45 5%

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9
Q

Presenting Sx cervical cancers

A

Asymptomatic
IMB/PCB/PMB
Dyspareuniria
Abnormal vaginal discharge
Abnormal speculum
Haematuia
Urinay incontince
Loin pain (hydronephrosis)
Weight loss
Change bladder/bowel

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10
Q

Peak age incidence of cervical carcinoma

A

25-29yrs
rare <25yrs

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11
Q

Cervical cancer %
localised/regional/mets at diagnosis

A

44% localised
34% regional
15% distant mets

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12
Q

How to Dx cervical cancer

A

Colposcopy and biopsy (punch Bx, multiple or LLETZ)

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13
Q

Where does cervical cancer spread locally

A

Vagina
Parametrium
Uterosacral ligaments

Bladder/rectum/para aorta lymph nodes

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14
Q

Where does cervical cancer spread distantly

A

Bone, liver, lungs

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15
Q

FIGO Stage 1a
1a1
1a2

A

1a Microscopic <5mm
1a1 Stromal <3mm
1a2 Stromal 3-5mm

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16
Q

Figo Stage 1b
1b1
1b2
1b3

A

Figo Stage 1b Deepest invasion >5mm
1b1 Dimension <2cm
1b2 Dimension 2-4cm
1b3 Dimension >4cm

17
Q

FIGO Stage 2

A

Metastasised to uterus not not lower 1/3 vagina or side wall

18
Q

Figo Stage 2a
2a1
2a2

A

Figo Stage 2a: upper 2/3 vagina, no parametrium
2a1 <4cm dimension
2a2 >4cm dimension

19
Q

FIGO stage 2b

A

Parametrial invasion no side wall

20
Q

FIGO stage 3

A

Further local spread
Lower 1/3
Pelvic side wall
Hydropnephrosis
Involves pelvic or para-aortic lymph noces

21
Q

FIGO
3a
3b

A

3a Lower 1/3 vagina
3b Pelvic side wall, hydronephrosis, non functioning kidney

22
Q

FIGO stage 3c
3c1
3c2

A

FIGO stage 3c Local Lymph nocdes
3c1 Pelvic
3c2 para-aortic

23
Q

FIGO stage 4
4a
4b

A

Beyond true pelvis, involved Bx proved mucosa bladder/rectum
4a Adjacent pelvic organs
4b distant organs

24
Q

5 year surgical stage 1 cervical cancer

A

95%

25
Q

5 year surgical stage 2 cervical cancer

A

70%

26
Q

5 year surgical stage 3 cervical cancer

A

40%

27
Q

5 year surgical stage 5 cervical cancer

A

15%

28
Q

What cross sectional imaging can be used pre-op for cancers above 1a

A

MRI > CT - diffusion weighted increases sensitivity

More accurate for staging
7-10 days after biopsy (prevent artefact)
High negative predictive value bladder/bowel involvement

Chest imaging - plain CXR

If nodal disease suspected → FDG PET CT (If >1b2)

Clinical examination also essential

29
Q

Gold standing for assessing lymph node mets

A

Sentinal lymph node biopsy - surgically

30
Q

Which cancers used Sentinal lymph node biopsy for staging?

A

Breast, vulval and cervical

Helps assess for chemo-radiotherapy

NPP 95%

31
Q

Surgical management for Stage 1a1 cervical cancer

A

Cold knife/Loop Coneisation with clear margins for cancer and dysplasia

Non-fragmented speculum

When completed family/fertility not desired → simple hysterectomy

32
Q

Complications from conisation (cone Bx, LLETZ)

A

Cervical imcompentence
Stenosis
Pre term delivery

33
Q

Surgical management Stage 1a2-1b2

A

Radical hysterectomy + BSO + pelvic lymphdenectomy

Fertility preservation - conisation/trachelectomy with clear margins

34
Q

If those with adneocarcinoma what else should they be counselled on?

A

BSO - risk of recurrence in adenxa

35
Q

Surgical options for fertility preservation for cervical cancer up to stage 1b1

A

Radical trachelectomy + cerclage + BL lymphdectomy +/- genital node Bx

consider up to 1b2

36
Q

When is adjacent chemo radiotherapy offered

A

Higher risk factors
Unclear margins
+ve pelvic lymph nodes
Parametrial spread

37
Q

Treatment for local spread 1b3 onwards

A

Chemoradiotherapy
External beam radiation, bracytherapy
Cisplatin chemotherapy

38
Q

When is pelvic excenteration offered

A

Some cases 4a disease

39
Q

Neoadjuvant chemotherapy before surgery or radiation

A