cervix Flashcards
where do most cervical cancers originate from
squamous-columnar junction
What proportion of CIN3 progresses to invasive cancer and over what timeframe
30% over 10yrs
When is cervical screening done and at what ages
25-49 = 3 yearly;
50-64 = 5 yearly
(65+ - only if one of the past 3 tests was abnormal)
What test is done on mild dyskaryosis seen at cervical screening, and how does this affect treatment
What is done for high grade dyskaryosis
Mild dyskaryosis - do HPV test
If positive - colposcopy
High grade - straight to colposcopy
If CIN2-3 -> LLETZ
What investigations are done for cervical cancer
EUA - Inspect vulva, vagina & bi-manual palpation of cervix / parametrial extension
Bloods
Biopsy
MRI pelvis
CT chest and PET for staging (If no PET, need para-aortic sampling)
Cystoscopy / Sigmoidoscopy if suspicious lesions in bladder or rectum
EDTA If having chemotherapy
Pregnancy test & Fertility preservation
How are stage 1 and 2 cervical cancers defined
Stage 1A - microscopic diagnosis only
1A1 - <3mm depth of invasion
1A2 - 3-5mm depth of invasion
Stage 1B - Clinically visible or >5mm depth of invasion
1B1 - <2cm
1B2 - 2-4cm
1B3 - >4cm
Stage 2 - involvement of top 2/3 of vagina or parametrium but not pelvic sidewall
What is included in a modified radical hysterectomy
When is it indicated for cervical cancer
Removes uterus, cervix, parametrium (diff degrees), fallopian tubes, upper 1/3 vagina
Indicated for a stage 1A2 cancer (with LND)
What is included in a radical trachelectomy
When is it indicated for cervical cancer
Removes cervix, parametrium and upper 1/3 of vagina
Indicated for stage 1A2 cancer (with LND)
Preserves fertility vs modified radical hysterectomy
What is the management of a stage 1A1 cervical cancer
Conisation
At what stage does CRT become indicated
Stage 1B3
What is the management of a stage 1B1-2 cervical cancer
Radical hysterectomy
What are the indications for adjuvant chemo-RT
What are the GTV/CTV volumes
What is the CTV-PTV margin
What dose/regimen is given
Indications:
Adj RT - ≥2 of >1/3 stromal invasion, LVSI+, tumour diameter >4cm (stage 2A2)
Addition of cisplatin - Positive margins, Positive nodes, Parametrial involvement
GTV - residual disease
CTV - Upper half of vagina, paravaginal tissue / parametrium, elective nodal volume
CTV-PTV margin 1cm
45Gy/25# +/- weekly cisplatin 40mg/m2, followed by brachytherapy boost of 8gy/2#
RT alone was shown to improve rates of local recurrence
Addition of cisplatin increased PFS and OS
What is the regimen for primary chemoRT for cervical cancer
What should also be included if low vaginal involvement
What is the benefit of cisplatin
Phase 1 - 45Gy/25# with weekly cisplatin 40mg/m2
Phase 2 - HDR brachy - 21Gy/3#, or EBRT 20Gy/10# (sequential or as SIB)
If low vaginal involvement - include whole vagina and inguinal nodes
Cisplatin - approx 10% benefit in OS
Overall treatment time should be <56 days
What is the regimen for systemic treatment of stage IVB cervical cancer
SCC:
Cisplatin/Carboplatin and paclitaxel + bevacizumab
Add pembrolizumab if PDL1 CPS >1
Benefit of pembro - PFS 10mths vs 8mths, mOS 24mths vs 16mths
Adeno:
Cisplatin/5FU
What structures should be included in a cervix RT plan
GTV - Tumour
HR-CTV - Tumour and rest of cervix
LR-CTV - to extend 3cm below GTV
HR-CTV +5mm margin ant/post at the level of the cervix, uterus, parametria, prox 2cm of vagina (if involved include 2cm below disease)
Elective nodal volumes - ext/int iliacs, common iliacs +/- PA nodes, obturator & pre-sacral nodes, inguinal nodes if lower 1/3 vagina involved
