Cervical cancers Flashcards

Question

How is screening recommendations different for immunocompromised people?

Answer 1

This includes HIV/AIDS In America they do first 2 smears 6 months apart then annually SLE, UC Immunosuppressive tx re cancer or organ transplants Guidelines for care Annual screening Refer to colp even if low grade changes Entire genital tract should be assessed (cervical, vaginal, anal and vulva) Excisional methods should be used and FU with colp and cytology FU infinite and annual

Answer 2

Increased risk of clear cell adenocarcinoma of the vagina and cx Increased risk HSIL and cervical cancer These woman should be given annual cytological screening and colposcopic exam of the cx and vagina screening should begin anytime and continue indefinitely

Answer 3

Post TAH Vault screening Aim of taking a smear of the vault is for the prevention of vaginal cancer If TAH for benign reasons, normal smear hx, and cx shows no malignant or premalignant change, then they do not require further screening If prev low grade smear that had reverted to normal before the hysterectomy and normal cx on histological exam then does not require further screening Woman with a hysterectomy for CIN 2/3 may be an increased risk of vaginal cancer and should have annual vault smears If previously Tx VAIN are at risk of developing VAIN and should have vault smears every 1-2 years If immunocompromised and have had a hysterectomy for benign disease she should have vault smears every 3 years

Answer 4

Hypertrophied cx hyperaemic Increased vaginal laxity Deciduosis in pregnancy can have an appearance suggestive of malignancy and the features of squamous metaplasia may be exaggerated Exaggerated vascular changes and patterns

Answer 5

Exclude invasive malignancy same guidelines for referral Low grade changes often resolve CIN 2/3 doesn't need treatment in pregnancy but less likely to resolve Biopsy safe but not necessarily needed

Answer 6

1/10 000 MRI for staging (not as good as CT for lymph nodes but this is contraindicated) Chemo may be possible MDT input can do a LND before 22 weeks and use that information to decide on further treatment <2cm + nodes - TOP - ve nodes - cone, trachelectomy or delay until maturity >2cm + nodes TOP -ve nodes Chemo and post partum OT After 22-25 weeks cant do LND Options are Chemo - stabilises tumor and prevents dissemination Await maturity and radical caesarean hysterectomy

Answer 7

67% antenatal Tx 37% chemotherapy 86% had live births 52% term deliveries Of the preterm 42% iatrogenic Risk of congential abnormalities was similar for the general population No difference in cognitive function Over time as increases treatment in pregnancy, less terminations, more cancer Tx, less prematurity bur more SGA and NICU admissions

Answer 8

Breast colorectal lung cervical In low and middle income countries cervical is second most common

Answer 9

Squamous 70-80% Keratinizing and non keratinising Glandular 10-15% Papillary tumors more likely adenocarcinoma Epithelial neuroendocrine Undifferentiated

Answer 10

It can be clinically, radiologically or pathologically staged FIGO has no recommendations for routine investigations MRI is best for parametrial involvement If in doubt - use the lower stage If frank invasive cancer then at least CXR and assessment for ureteric obstruction should be done Cystoscopy: Symptoms if tumor in anterior vaginal wall Barrel shaped endocervical growth

Answer 11

The carcinoma is strictly confined to the cervix uteri (extension to the corpus should be disregarded) IA Invasive carcinoma that can be diagnosed only by microscopy, with maximum depth of invasion <5 mma ○IA1 Measured stromal invasion <3 mm in depth ○IA2 Measured stromal invasion ≥3 mm and <5 mm in depth IB Invasive carcinoma with measured deepest invasion ≥5 mm (greater than stage IA), lesion limited to the cervix uteri ○IB1 Invasive carcinoma ≥5 mm depth of stromal invasion and <2 cm in greatest dimension ○IB2 Invasive carcinoma ≥2 cm and <4 cm in greatest dimension ○IB3 Invasive carcinoma ≥4 cm in greatest dimension

Answer 12

The carcinoma invades beyond the uterus, but has not extended onto the lower third of the vagina or to the pelvic wall IIA Involvement limited to the upper two‐thirds of the vagina without parametrial involvement ○IIA1 Invasive carcinoma <4 cm in greatest dimension ○IIA2 Invasive carcinoma ≥4 cm in greatest dimension IIB With parametrial involvement but not up to the pelvic wall

Answer 13

The carcinoma involves the lower third of the vagina and/or extends to the pelvic wall and/or causes hydronephrosis or non‐functioning kidney and/or involves pelvic and/or paraaortic lymph nodesc IIIA Carcinoma involves the lower third of the vagina, with no extension to the pelvic wall IIIB Extension to the pelvic wall and/or hydronephrosis or non‐functioning kidney (unless known to be due to another cause) IIIC Involvement of pelvic and/or paraaortic lymph nodes, irrespective of tumor size and extent (with r and p notations)c ○IIIC1 Pelvic lymph node metastasis only ○IIIC2 Paraaortic lymph node metastasis

Answer 14

The carcinoma has extended beyond the true pelvis or has involved (biopsy proven) the mucosa of the bladder or rectum. A bullous edema, as such, does not permit a case to be allotted to stage IV IVA Spread of the growth to adjacent organs IVB Spread to distant organs

Answer 15

●Active collagen vascular disease, which is a well-known relative contraindication to radiotherapy [4]. ●Inflammatory bowel disease (IBD) – Patients with IBD may be at an increased risk of acute and late bowel complications [5], although the data appear to be conflicting, especially when trying to tease out the effects related to RT from those that might be related to the natural history of IBD [6,7]. ●Vascular disorders – Retrospective data suggest that diabetes and hypertension may increase the risk for late toxicity, presumably related to microvascular disease. This includes reports of a greater preponderance of significant bowel complications following definitive radiation for cervix cancer [8,9], although the presence of these conditions was not associated with a greater risk for acute toxicity in at least one report that included women with endometrial cancer

Answer 16

The two types of radiation therapy most often used to treat cervical cancer include: External beam radiation Brachytherapy There are two types of brachytherapy: Low-dose rate (LDR) brachytherapy is completed over a few days. During this time, the patient stays in bed in a private room in the hospital with instruments holding the radioactive material in place. While the radiation therapy is being given, the hospital staff will care for you, but also take precautions to lessen their own radiation exposure. High-dose rate (HDR) brachytherapy is done as an outpatient over several treatments (often at least a week apart). For each high-dose treatment, the radioactive material is inserted for a few minutes and then removed. The advantage of HDR treatment is that you do not have to stay in the hospital or stay still for long periods of time.

Answer 17

Skin irritation Skin changes: As the radiation passes through the skin to the cancer, it can damage the skin cells. This can cause irritation ranging from mild, short-term redness to peeling. The skin may release fluid, which can lead to infection, so the area exposed to radiation must be carefully cleaned and protected. Irritation of Bowel, The small bowel is very sensitive to the early effects of RT, and when it is contained within the RT field, radiation injury can present acutely as nausea and vomiting. bladder – radiation cystitis It can be associated with irritative voiding symptoms (dysuria, frequency, urgency, and nocturia) and bladder spasms. It is due to RT-induced bladder inflammation and edema, which can compromise urothelial integrity vagina, Radiation can make the vulva and vagina more sensitive and sore, and sometimes causes a discharge. menopause, infertility Fatigue

Answer 18

Long term toxicity Radiation fibrosis urinary retention / urgency Late GU toxicities generally arise as a result of RT-induced epithelial and microvascular changes, which can lead to changes in bladder physiology. These changes are often permanent and are largely mediated by fibrosis via collagen deposition within the epithelium and muscularis, resulting in diminished bladder capacity and loss of tissue compliance. Though the pathophysiology differs, late bladder effects can result in a similar spectrum of lower urinary tract symptoms to that seen in the acute phase, such as urgency and frequency. This is often attributed to bladder overactivity or contraction. With significant contraction, bladder dysfunction can result in urge incontinence. GIT irritation ● Chronic diarrhea – When present symptoms may be best managed by a multidisciplinary team to include gastroenterology. Ongoing antidiarrheal medications are often necessary. - Malabsorption – This can be related to RT involving the distal ileum. For example, vitamin B12 deficiency after irradiation for cervical cancer occurs in 12 to 20 percent. This usually develops over a period of several years and commonly requires replacement [40-42]. Cholestyramine may be helpful when bile salt malabsorption is present. ●Recurrent bouts of ileus or obstruction. This is best managed conservatively when possible, but commonly requires surgery with resection and anastomosis. Prolonged chronic radiation enteritis can lead to malnutrition, and as such, perioperative nutritional therapy may be an important intervention. ●Proliferative mucosal telangiectasias or ulcerations – The development of mucosal telangiectasias and/or ulcerations is related to vascular sclerosis and is most commonly observed in the rectosigmoid colon (radiation-induced proctopathy). The signs can include painless hematochezia, tenesmus, or pain. In addition, characteristic changes of mucosal pallor and proliferative telangiectasias often are seen on the anterior rectal wall on endoscopic evaluation in asymptomatic patients. When present, the median time to onset is 14 months and symptoms typically appear within three years ●For patients with rectal proctopathy, conservative management is often appropriate. Avoiding constipation may limit episodes of bleeding. fistulas vaginal stenosis Both EBRT and brachytherapy can cause stenosis Encourage frequent sex / dilator pelvic fractures Hip fractures are the most common, and might occur 2 to 4 years after radiation. Bone density tests are recommended to monitor the risk of fracture. menopause In premenopausal women <40 years old, laparoscopic ovarian transposition may be employed before a course of pelvic radiation - it is desirable for the transposed ovary to be at least 3 cm from the radiation field border. Often, clips are used to allow the radiation oncologist to identify the ovaries' new location. High rates of preservation (80 to 88 percent) have been reported, with an improved likelihood of success when both ovaries are transposed If pelvic lymph nodes are tx with radiotherapy - lymphodema

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Cervical cancers Flashcards

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