Cervix Flashcards
What is the cervix?
The cervix is the lower 1/3 of the uterus where it connects with the superior portion of the vagina.
What is the internal os?
The internal os is part of the cervix that is closest to the body of the uterus.
What is the external os?
The external os is the opening of the cervix on the vaginal end.
What type of epithelium lines the external os?
The external os is lined with squamous cell epithelium.
What is the exocervix?
The exocervix is the part of the cervix closest to the vagina.
What is the rank of cervix cancer among common cancers in women?
It is the 3rd most common cancer in women.
What age group is cervix cancer most common in?
It is most common in women under 50 years old.
In which socioeconomic groups is cervix cancer commonly found?
It is common in low socioeconomic groups.
What is the most important risk factor for cervix cancer?
Human Papilloma Virus (HPV) is the most important risk factor.
What are the estimated new cases of cervix cancer in 2024?
13,820 estimated new cases.
What are the estimated deaths from cervix cancer in 2024?
4,360 estimated deaths.
What is the incidence rate of cervix cancer from 2016-2020?
The incidence rate is 7.7 per 100,000.
What is the mortality rate of cervix cancer from 2017-2021?
The mortality rate is 2.2 per 100,000.
What is the most common presenting symptom of cervical cancer?
Abnormal vaginal bleeding
What bowel symptoms are associated with advanced cervical cancer?
Bowel symptoms are usually related to advanced disease with tumor invasion into the rectum.
At what age should women begin cervical cancer testing?
All women should begin cervical cancer testing (screening) at age 21.
How often should women aged 21 to 29 have a Pap test?
Women aged 21 to 29 should have a Pap test every 3 years.
Should HPV testing be used for screening in women aged 21 to 29?
HPV testing should not be used for screening in this age group.
How often should women aged 30 and older have Pap and HPV co-testing?
Women aged 30 and older should have Pap and HPV co-testing every 5 years.
What is colposcopy?
Colposcopy is performed on women who have abnormal Pap smear results or who are at a high risk for the development of cervical cancer.
What is cervical cancer?
Cervical cancer starts in the cells lining the cervix.
What are the two parts of the cervix?
The cervix is made of two parts: the endocervix and the exocervix.
What type of cells cover the endocervix?
The endocervix is covered with glandular cells.
What type of cells cover the exocervix?
The exocervix is covered in squamous cells.
What is the transformation zone?
The place where the endocervix and exocervix meet.
What is the most common histology of cervical cancer?
Squamous cell carcinoma.
What are the other types of cervical cancer histology?
Adenocarcinoma and adenosquamous carcinoma.
What is the most commonly used staging system for cervix staging?
FIGO
What is the most significant prognostic factor in cervix staging?
Staging
What does cervix staging 1b indicate?
Cancer has grown into the top part of the vagina.
What size is classified under cervix staging 2a?
4mm or smaller.
What does cervix staging 2b indicate?
Cancer has grown into the top part of the vagina.
What does cervix staging 1b2 indicate?
Larger than 4mm.
What does cervix staging 3a indicate?
Cancer has grown into the lower third of the vagina.
What type of tumors are cervical cancers?
Cervical cancers are slow-growing tumors that directly invade adjacent tissues.
What is the process of metastasis in cervical cancer?
Metastasis includes direct extension into the uterus, the vagina, the parametrium, the abdomen, the pelvis, the rectum, and the bladder.
How does lymphatic involvement occur in cervical cancer?
Lymphatic involvement is usually orderly, involving parametrial nodes, common iliac, periaortic, and even supraclavicular nodes.
What are the hematogenous routes for cervical cancer spread?
Cervical cancer may also spread via hematogenous routes.
What are the most common distant sites involved in cervical cancer metastasis?
The most common distant sites involved are the lungs, the liver, and bone.
What nodes are involved in the lymphatic spread of cervical cancer?
The involved nodes include periaortic nodes, common iliac nodes, external iliac nodes, internal iliac nodes, and obturator nodes.
What is a common treatment for early staged cervical cancer?
Surgery, specifically Total Abdominal Hysterectomy (TAH) with or without a small amount of vaginal tissues, referred to as the vaginal cuff.
When should radiation therapy be considered for cervical cancer?
If the tumor is still confined to the cervix but surgical removal is not possible.
How are patients with advanced stage cervical cancer treated?
They are treated with radiation with or without chemotherapy.
What does EBRT target in cervical cancer treatment?
EBRT targets the pelvic lymph nodes, parametria, and primary tumor, to a dose adequate to control microscopic disease.
What is the purpose of chemotherapy in cervical cancer treatment?
Chemotherapy serves predominantly as a radiosensitizer.
What is the benefit of a therapy boost in cervical cancer treatment?
It boosts the gross tumor and improves disease control.
What type of beams are necessary for external beam treatment of cervical cancer?
High-energy photon beams are necessary due to the thickness of the pelvic area.
What are the techniques used for radiation treatment in cervical cancer?
Four field box, IMRT, and VMAT are the techniques used.
What is the typical dose for whole pelvis with EBRT?
The typical dose is 40-50 Gy plus intracavitary brachytherapy.
What are the tumor total doses for cervical cancer?
Tumor total doses are increased from 70 Gy for low-volume disease to 85 Gy for advanced or bulky disease.
What are the organs at risk (OARs) in cervical cancer radiation treatment?
The organs at risk include the rectum and bladder.
What helps avoid organs at risk (OARs) in radiation treatment?
Numerous dose, field, and sequence arrangements help avoid OARs.
What is the goal of intracavitary radiation for cervical cancer?
To deliver 50 to 60 Gray to microscopic disease, 60 to 70 Gray to small macroscopic disease, and 70 to 90 Gray to large macroscopic disease while limiting the volume and dose to the bladder, colorectal tissues, and small intestine.
Where is Point A located?
Point A is located 2 cm cephalad and 2 cm lateral from the external cervical os.
Where is Point B located?
Point B is located 5 cm lateral to the center of the pelvis at the same level as Point A.
What are the components involved in the intracavitary radiation procedure?
Uterine cavity, external os of cervix, tandem with sources, and vagina.
What is the purpose of external beam treatment in brachytherapy for cervical cancer?
Shrinkage of bulky tumor during the external beam portion of the treatment results in better geometry for the brachytherapy implant.
What are the components used in brachytherapy for cervical cancer?
A standard intrauterine tandem and vaginal colpostats are placed laterally to the tandem into the vaginal fornixes.
What is the radioactive source used in LDR brachytherapy?
LDR- Cesium-137 delivered over 1-2 fractions, with treatment times of typically 1-3 days, requiring prolonged patient immobilization.
What is the radioactive source used in HDR brachytherapy?
HDR- Iridium-192 delivered at a point A dose rate of >12 Gy/hour.
What are the advantages of HDR brachytherapy?
Advantages of HDR include precise positioning of the source, shorter treatment times (minutes versus days), and protection of health care personnel from radiation exposure.
Where are the ovoids placed for cervical cancer treatment?
The ovoids are placed in the lateral fornix on both sides of the cervix, as close to the pelvic sidewall as possible.
What shape does the dose distribution result in for cervical cancer treatment?
This results in a pear-shaped dose distribution.
What are the acute side effects of radiation treatment for cervical cancer?
Fatigue, Diarrhea (if radiation is given to the pelvis or abdomen), Cystitis, Nausea, Anorexia, Skin changes
What are the chronic side effects of radiation treatment for cervical cancer?
Chronic cystitis, Proctosigmoiditis, Small bowel enteritis, Obstruction
