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Pelvis and Abdomen: R&O > Cervix > Flashcards

Cervix Flashcards

1
Q

incidence

A

common in younger women (25+)
screening from 25

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2
Q

presentation

A

discharge: dark in colour and odour

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3
Q

diagnosis

A

colposcopy and biopsy

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4
Q

what staging system is used

A

FIGO

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5
Q

what is CIN

A

cervical intraepithelial neoplasia

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6
Q

what is CIN I-III

A

pre-malignant change
follow up at 6 and 24 months

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7
Q

what is the common pathology

A

SCC (80-90%)

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8
Q

what is cervical cancer linked with

A

HPV and damage to the transitional zone
theses a vaccine for HPV

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9
Q

what are the other pathology types

A

adenocarcinoma (columnar of the endocervix)
rare: small cell carcinoma

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10
Q

what can early stage result in

A

surgical removal

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11
Q

stage 0

A

pre malignant, screening as asymptomatic

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12
Q

stage I

A

very localised growth

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13
Q

IA

A

asymptomatic, only picked up through screening

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14
Q

IB

A

invasive disease

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15
Q

II

A

direct local spread, not extending within the parametric

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16
Q

management for IA/IB

A

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

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17
Q

management for II-IVA

A

chemoradiation: cisplatin + EBRT + ICBT

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18
Q

management for IVB

A

rare
palliative chemo: carbo + pacilitaxel
EBRT for symptom control

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19
Q

what is stage I

A

small, may spread to LN not to other body parts

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20
Q

what is stage II

A

larger have have spread outside uterus and cervix to/ or LN

21
Q

what is stage III

A

spread to lower vagina or to pelvis

22
Q

what is stage IV

A

outside the pelvis to organs like lung, bone and liver

23
Q

CIN

A

glandular epithelium of endocervix

24
Q

CIN I

A

watch and wait

25
Q

CIN II-III

A

conisation

26
Q

CKC

A

no difference in outcomes

27
Q

where is direct spread

A

uterus (sup), further into the cervix

28
Q

where is lymphatic spread

A

paramterium
later on common iliac and para-aortic

29
Q

what investigations take place

A

EUA = examine the uterine cavity, paramteria cystoscopy + sigmoidscopy
CT/MRI = visualise nodes, thorax/lung - local node invasion and spread
FBC+LFT

30
Q

describe stage I

A

I = confined to cervix
IA = micro invasive diagnosed by microscopy <3
IB = clinically invasive

31
Q

describe stage II

A

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

32
Q

describe stage III

A

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

33
Q

describe stage IV

A

spread beyond the true pelvis into bladder or rectum
distant mets
IVA= adjacent organs
IVB= distant site

34
Q

what is the management for stage IIA

A

radical hysterectomy: cervix, uterus, ovaries, FT paramterium and vaginal cuff removed

35
Q

what may be introduced for young women

A

an artificial menopause, with the ovaries going into situ

36
Q

what does recurrence result in

A

a pelvic exenteration
cervix, uterus, ovaries, partial or total vagina removed + LN and other pelvic organs like bladder or part bowel

37
Q

describe chemo

A

cis-platin is commonly used
appropriate for FIGO IB+
chemorad once a week for 4 cycles

38
Q

SE

A

nausea
vomiting
temporary hair loss
nephrotoxicity (dose limiting) - kidney tests are important
tinnitus or hearing loss
neurotoxicity - loss of pro perception

39
Q

describe EBRT

A

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

40
Q

describe RT

A

45Gy in 25
2 cups in 30
daily CBCT
daily US
glycerin suppository

41
Q

when is RT given

A

IA+

42
Q

describe RT for IA+

A

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

43
Q

what is the high risk residual disease

A

close or involved surgical margins
lymphovascular invasion
nodal involvement

44
Q

IMRT

A

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

45
Q

describe the dosimetry for BT

A

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

46
Q

what is point A

A

approx anatomical position of ureter [2cm sup and 2cm lat], dose prescribed here

47
Q

what is point B

A

falls on the lat side of pelvis wall [2cm sup, 3cm lat from point A] at roughly the pelvic all

48
Q

radiation dose prescription for BT

A

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)

Pelvis and Abdomen: R&O (22 decks)

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