Gynecologic malignancy - cervical cancer Flashcards
what co-factors are important in cervical cancer disease development
- smoking
- immunocompromise
Liquid based cytology is used because
- lower false negative rate
- increased sensitivity
- less interference by blood/mucous cells
False negative rate in cervical cytology screening
10- 50% false negatives
when do you start/stop screening for cervical ca
at age 21
- stop age 65-70 or post hysterectomy with normal pap Hx
Cervical cytology screening is NOT
Diagnostic
When can you repeat a cervical screen
after 3 months
Who gets sent for colposcopy based on screen?
Everyone except ASC, and ASC-US
cervical epithelial cells can be
Squamous or glandular
what are some alternative causes for abnormal cervical cytology?
infection/inflammation
- cancer other genital source
- regeneration after injury
- post menopausal/postpartum
Results for which type of lesions are more predictive in cytopath for cervix?
- Squamous lesions
- glandular lesions harder -
what is a koliocyte?
HPV infected cell -
enlarged,irregular, dark, bi-nucleus with a halo
A koliocyte is diagnostic for
low grade lesion
classical cytology of glandular lesions
Loss of honeycomb apperance,
- adenocarcinoma in situ,
how do you treat cervical dysplasia
- cone biopsy, or LEEP
- or ablate if you can see the entire lesion
warning symptoms for cervical cancer
- abnormal pap
- post-coital bleeding
- mentometrorrhagia
- post menopausal bleed
- pelvic pain
- vag discharge
- FLANK pain, sciatica, lower limb edema
Why can there be flank pain, sciatica and lower limb edema in cervical cancer
- pressing on ureter
- femoral nerves
- and femoral vein
diagnostic test for cervical lesion detection
BIOPSY!! cervical biopsy - or through colposcopy
cervical cancer is staged
CLINICALLY not surgically -
tests that may affect treatment decisions, but do NOT change stage
CT , MRI lymphangiography, PET scan, laproscopy
the best role for HPV testing is for which type of lesions?
ASC-US
what is the diagnostic evaluation of cervix include
Colposcopy!
If lesion is >4cm or have advanced disease what is the clinical management?
- chemoradiation
Is disease is in early stage
- radical hysterectomy + pelvic nodes OR
- Chemoradiation -
2 most common HPV-induced cervical cancers by histopathology
1) squamous cell carcinoma
2) endocervical adenocarcinoma
If tumor is confined to cervix - outcome is
favorable - cured with Sx and Radiation
-
If tumor is advanced stage
- no surgery
- chemo radiation/palliation
what is highly prognostic in cervical cancer
lymph node involvement
Toxicity of therapy for cervical cancer
- loss of fertility
- menopause
- impaired sexual function
- bowel/bladder toxicity
