Gyn Onc Flashcards
HPv infection persistence risks (2)
Immunocompromised and smoking
Cervical staging
Figo
I:cervix only
A <5mm
A1<3mm
A2>3mm
B >5mm
II: beyond cervix
III: beyond uterus or pelvic nodes
IV: beyond true pelvis, bladder, rectum or distant met
Ia1 cervical treatment and define stage
Simple hysterectomy or cone
Stage ia2 treatment and define stage cervical
Radical hysterectomy or trachelectomy with LN dissection or chemorads
Stage IB 1/2 treatment cervical and define stage
Radical hysterectomy or trachelectomy with LN dissection or chemorads
<4mm depth
Locally advanced cervical define stage
Chemo rads (cisplatin)
Ib3 up to ivb
Radical vs simple hysterectomy
Radical includes parametrium (tissue around uterus that contains ureters), increased risk
Adjuvant therapy cervical indications
Positive surgical margins, pos nodes, parametria involved is chemorads
Intermediate risk sedlis criteria +/- rads
Chemo rads includes 2 parts; chemo schedule cervical
External beam and brachytherapy, weekly cisplatin during rads (chemo adds sig survival benefit) 40 mg/m2 for 5-6 weeks
Localized recurrent disease cervical
Surgery if had rads: pelvic exenteration cure rate 30-50%, but morbid (colostomy and illeal conduit, flaps)
Rads if had surgery
Stage ivb disease and first line regimen cervical
Palliative chemo includes:
Cisplatin and taxol
Carbo and taxol no major difference in trial so this can and is often used instead
Stat sig benefit with addition of bevacizumab to above (17 vs 13 mo) higher 48% RR, fistula risk
Second line options cervical
Check pdl1/ cps
15-18% RR
Pdl1+/ cps1
Tisotumab Vedotin ADC
Single agent chemo 5-10% RR
Uterine staging
I uterus
II cervix
III local regional spread inc nodes
IV bowel bladder or Mets
Stage I treatment
Surgery; then rads depending on invasion and grade of cancer
Stage iiia/b uterine
Chemo +/- rads
Stage iiic uterine treatment
Chemo/rt + tc x4
Systemic therapy uterine first and subsequent lines
Carbo taxol standard of care first line
+/- herceptin (her2+)
Or hormonal if endometrioid
Second line
Msi testing then
Lenvatinib/pembro—> mss good responses
Pembro alone for msih
Then
Everolimus letrozole (endometrioid)
Bevacizumab alone (no benefit with chemo)
Second line chemo RR 15-20%
Uterine carcinosarcoma management
Resect
Carbo taxol over ifos taxol
Rads helps with local recurrence not os
Then standard uterine other second lines
Leiomyosarcoma management
Resect
1st line gem taxotere
Rads for local control not os
Then other sarcoma regimens
Treatment of endometrial stromal sarcoma
Hormone responsive, megestrol acetate
