Cervix Flashcards
incidence
common in younger women (25+)
screening from 25
presentation
discharge: dark in colour and odour
diagnosis
colposcopy and biopsy
what staging system is used
FIGO
what is CIN
cervical intraepithelial neoplasia
what is CIN I-III
pre-malignant change
follow up at 6 and 24 months
what is the common pathology
SCC (80-90%)
what is cervical cancer linked with
HPV and damage to the transitional zone
theses a vaccine for HPV
what are the other pathology types
adenocarcinoma (columnar of the endocervix)
rare: small cell carcinoma
what can early stage result in
surgical removal
stage 0
pre malignant, screening as asymptomatic
stage I
very localised growth
IA
asymptomatic, only picked up through screening
IB
invasive disease
II
direct local spread, not extending within the parametric
management for IA/IB
IA = cone biopsy
IA/IB = simple hysterectomy of the Cervi, uterus, FT, parametria, ovaries left to prevent early menopause
IB = surgery
TAH+BSO
trachelectomy removes the cervix and involved nodes and preserves the uterus and ovaries so can potentially have a baby, not invasive
management for II-IVA
chemoradiation: cisplatin + EBRT + ICBT
management for IVB
rare
palliative chemo: carbo + pacilitaxel
EBRT for symptom control
what is stage I
small, may spread to LN not to other body parts
what is stage II
larger have have spread outside uterus and cervix to/ or LN
what is stage III
spread to lower vagina or to pelvis
what is stage IV
outside the pelvis to organs like lung, bone and liver
CIN
glandular epithelium of endocervix
CIN I
watch and wait
CIN II-III
conisation
CKC
no difference in outcomes
where is direct spread
uterus (sup), further into the cervix
where is lymphatic spread
paramterium
later on common iliac and para-aortic
what investigations take place
EUA = examine the uterine cavity, paramteria cystoscopy + sigmoidscopy
CT/MRI = visualise nodes, thorax/lung - local node invasion and spread
FBC+LFT
describe stage I
I = confined to cervix
IA = micro invasive diagnosed by microscopy <3
IB = clinically invasive
describe stage II
II = spread beyond the uterus to the upper vagina not pelvis side wall or lower vagina
IIA = no paramteria involved
IIB = into paramteria leaving origin
describe stage III
spread to pelvic side wall and/or lower vagina and/or causes hydronephrosis or non functioning kidney and/or involves pelvis an/or para-aortic nodes
IIIA = spread to lower vagina NOT pelvic side wall
IIIB = spread to pelvic side wall +/- hydronephrosis or non functioning kidney
IIIC = involvement of pelvic +/- para-aortic nodes
describe stage IV
spread beyond the true pelvis into bladder or rectum
distant mets
IVA= adjacent organs
IVB= distant site
what is the management for stage IIA
radical hysterectomy: cervix, uterus, ovaries, FT paramterium and vaginal cuff removed
what may be introduced for young women
an artificial menopause, with the ovaries going into situ
what does recurrence result in
a pelvic exenteration
cervix, uterus, ovaries, partial or total vagina removed + LN and other pelvic organs like bladder or part bowel
describe chemo
cis-platin is commonly used
appropriate for FIGO IB+
chemorad once a week for 4 cycles
SE
nausea
vomiting
temporary hair loss
nephrotoxicity (dose limiting) - kidney tests are important
tinnitus or hearing loss
neurotoxicity - loss of pro perception
describe EBRT
primary + primary nodes + wide field
followed by BT (HDR)
high doses externally and internally
can be 3 or 4 field box, low weight post field
45-50Gy, 1.8-2.2Gy per fraction for 4.5/5 weeks
cisplatin - concurrent 5 weeks weekly
followed by BT
describe RT
45Gy in 25
2 cups in 30
daily CBCT
daily US
glycerin suppository
when is RT given
IA+
describe RT for IA+
locally advanced no distant spread
non lymphatic daring, spread is common: medial external, internal iliac, obturator [less common in common and para-aortic]
wide field, if no nodes then a narrow field can be used
primary radical = bulky IB, II, III, IV + BT
what is the high risk residual disease
close or involved surgical margins
lymphovascular invasion
nodal involvement
IMRT
reduces dose to normal tissues
minimise rectum size via an enema
inter fractional movement of 30mm in S-I direction and 15mm in A-P direction
1,2,3 weekly imaging
describe the dosimetry for BT
point A & B are reference points
dose is prescribed at point A
measured from the lowest part of uterus (external os), position of radioactive substances
what is point A
approx anatomical position of ureter [2cm sup and 2cm lat], dose prescribed here
what is point B
falls on the lat side of pelvis wall [2cm sup, 3cm lat from point A] at roughly the pelvic all
radiation dose prescription for BT
encompasses a 2cm radium around the cervix
when tumour extends this EBRT is involved
rectal dose - max 2/3 of dose prescription
HDR - max fraction size is 7Gy
14Gy in 2 fractions (following 45Gy in 25 of EBRT)
