Gyne Flashcards
Cervix staging figo
T1 - confined to uterus
T2 - invades beyond uterus but not pelvic wall or lower third of vagin; a-no parametrial invasion, b-parametrial invasion
T3 - invades structures above or kidney
t4 - invades bladder or rectum (a) OR distant mets (b)
most common pathology for cervical ca
scc
adenoca (20%) more likely to have nodal involvement
risk factors for cervical ca
hpv early sex history of stis high number sex partners tobacco prolonged oral conceptive
MC site of distant mets cervical
lung
MC LN involved cervical
internal, external, presacral, common, paraaortic
MC clin pres cervical and some others
abnormal vaginal bleeding**
postcoital spotting
abnormal vaginal discharge
PAP smear guidlines
starting at 21 unless sexually active
every 3 years after
most important prog factor cervical
nodal involvement
when should brachy be initiatied for cervical
following EBRT
when might brachy be the definitive tx for cervical
very early stage or non-surgical candidates
why is hdr preferred over ldr for cervical
hdr allows for flexibility in dose distribution and decreased exposure to personnel
point a placement cervical brachy
2cm sup to cervical os
2cm lat to tandem
point b placement cervical brachy
2cm sup to cervical os
5cm lat to pt midline
cervical contouring
whats included for ctv1, 2, 3
1 - gtv + cervic and entire uterus
2 - parametria, ovaries, vaginal tissue
3 - internal, external, common iliac chains
ptv 1.5 margin
RT dose for stage 1a cervical
ebrt 45
brachy 6Gy x 4 (24)
RT dose for cervical stage 1b-4 N0/1
EBRT 45-50Gy
brachy 5.5-6Gy x 5 (27.5)
with possible parametrial boost
concurrent chemo (disease greater than 4cm) warrants lower brachy
risk factors for endometrial ca
unopposed estrogen exposure tamoxifen use older age lynch syndrome diabetes mellitus
MC clin pres endometrium
vaginal bleeding or discharge
MRI for endometrial ca is not helpful for detecting nodal or peritoneal spread but it is good at…??
demonstrating the depth of myometrial invasion
CT of abdopelv can detect nodal and peritoneal spread
what tumor marker is associated with endometrial ca
ca-125
therefore one might test a pt for this through diagnostic evaluation
figo staging for endometrial ca
Stage 1 – confined to uterus (a - <50% of myometrium, b - >50% of myometrium)
Stage 2 – spread to cervical stroma (not just cervical glandular tissues)
Stage 3 – spread to adjacent connective tissue, vagina, or regional lymphatics
Stage 4 – spread to other pelvic organs, distant lymphatics, and distant mets
MC pathology of endo ca
adenoca
most important prog indicator for endo ca
stage
treatment for early stage endo ca
Surgery - TAH + BSO
adjuvant chemo for stage 2 g3 disease
adjuvant RT depending on histological factors and nodal involvement or residual
brachy may also be an option (stage 1a g3, 1b g1-3)
treatment for advanced stage endo ca
TAH + BSO
pelvic ebrt (could be extended fields)
chemo
- hormonal therapy has not shown benefit for this ca
- for inoperable, definitive RT
RT doses for endometrial ca
45-50Gy EBRT
brachy boost - 6Gy x 2-3fxs
brachy alone 21Gy/3
