Cervical_Cancer_Flashcards
How is the management of cervical cancer determined?
The management of cervical cancer is determined by the FIGO staging and the wishes of the patient to maintain fertility.
What is FIGO stage IA in cervical cancer?
FIGO stage IA is confined to the cervix, only visible by microscopy, and less than 7 mm wide (A1 = < 3 mm deep, A2 = 3-5 mm deep).
What is FIGO stage IB in cervical cancer?
FIGO stage IB is confined to the cervix, clinically visible or larger than 7 mm wide (B1 = < 4 cm diameter, B2 = > 4 cm diameter).
What is FIGO stage II in cervical cancer?
FIGO stage II indicates extension of the tumour beyond the cervix but not to the pelvic wall (A = upper two thirds of vagina, B = parametrial involvement).
What is FIGO stage III in cervical cancer?
FIGO stage III indicates extension of the tumour beyond the cervix and to the pelvic wall (A = lower third of vagina, B = pelvic side wall).
What is FIGO stage IV in cervical cancer?
FIGO stage IV indicates extension of the 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 are stage IA tumours managed in cervical cancer?
Management of stage IA tumours includes hysterectomy +/- lymph node clearance, cone biopsy with negative margins for patients wanting to maintain fertility, and radical trachelectomy for A2 tumours.
How are stage IB tumours managed in cervical cancer?
Management of stage IB tumours includes radiotherapy with concurrent chemotherapy for B1 tumours and radical hysterectomy with pelvic lymph node dissection for B2 tumours.
How are stage II and III tumours managed in cervical cancer?
Management of stage II and III tumours involves radiation with concurrent chemotherapy. Nephrostomy should be considered if hydronephrosis is present.
How are stage IV tumours managed in cervical cancer?
Management of stage IV tumours involves radiation and/or chemotherapy, with palliative chemotherapy being the best option for stage IVB.
What is the management of recurrent cervical cancer?
Management of recurrent cervical cancer involves chemoradiation or radiotherapy for primary surgical treatment, and surgical therapy for primary radiation treatment.
What is the 1-year survival rate for FIGO stage I cervical cancer?
The 1-year survival rate for FIGO stage I cervical cancer is 99%.
What is the 5-year survival rate for FIGO stage I cervical cancer?
The 5-year survival rate for FIGO stage I cervical cancer is 96%.
What are the short-term complications of radiotherapy for cervical cancer?
Short-term complications of radiotherapy for cervical cancer include diarrhoea, vaginal bleeding, radiation burns, pain on micturition, and tiredness/weakness.
What are the long-term complications of radiotherapy for cervical cancer?
Long-term complications of radiotherapy for cervical cancer include ovarian failure, fibrosis of bowel/skin/bladder/vagina, and lymphoedema.
summarise cervical cancer
Cervical cancer: management
The management of cervical cancer is determined by the FIGO staging and the wishes of the patient to maintain fertility.
FIGO Staging
FIGO Stage Description
IA Confined to cervix, only visible by microscopy and less than 7 mm wide:
A1 = < 3 mm deep
A2 = 3-5 mm deep
IB Confined to cervix, clinically visible or larger than 7 mm wide:
B1 = < 4 cm diameter
B2 = > 4 cm diameter
II Extension of tumour beyond cervix but not to the pelvic wall
A = upper two thirds of vagina
B = parametrial involvement
III Extension of tumour beyond the cervix and to the pelvic wall
A = lower third of vagina
B = pelvic side wall
NB: Any tumour causing hydronephrosis or a non-functioning kidney is considered stage III
IV 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
Management by Stage 1
Management of stage IA tumours
Gold standard of treatment is hysterectomy +/- lymph node clearance
Nodal clearance for A2 tumours
For patients wanting to maintain fertility, a cone biopsy with negative margins can be performed
Close follow-up of these patients is advised
For A2 tumours, node evaluation must be performed
Radical trachelectomy is also an option for A2
Management of stage IB tumours
For B1 tumours: radiotherapy with concurrent chemotherapy is advised
Radiotherapy may either be bachytherapy or external beam radiotherapy
Cisplatin is the commonly used chemotherapeutic agent
For B2 tumours: radical hysterectomy with pelvic lymph node dissection
Management of stage II and III tumours
Radiation with concurrent chemotherapy
See above for choice of chemotherapy and radiotherapy
If hydronephrosis, nephrostomy should be considered
Management of stage IV tumours
Radiation and/or chemotherapy is the treatment of choice
Palliative chemotherapy may be best option for stage IVB
Management of recurrent disease
Primary surgical treatment: offer chemoradiation or radiotherapy
Primary radiation treatment: offer surgical therapy
Prognosis
The prognosis of cervical cancer is dependant on the FIGO staging.
FIGO Stage 1-Year Survival 5-Year Survival
I 99% 96%
II 85% 54%
III 74% 38%
IV 35% 5%
Complications of Treatments
Complications of surgery
Standard complications (e.g. bleeding, damage to local structures, infection, anaesthetic risk)
Cone biopsies and radical trachelectomy may increase risk of preterm birth in future pregnancies
Radical hysterectomy may result in a ureteral fistula
Complications of radiotherapy
Short-term: diarrhoea, vaginal bleeding, radiation burns, pain on micturition, tiredness/weakness
Long-term: ovarian failure, fibrosis of bowel/skin/bladder/vagina, lymphoedema
