ONCOLOGY MANAGEMENT Flashcards
What are main Epidemiology of Cervical Cancer
- 14th Most common in UK
- More common in White and Black females
- Highest Incidence in 30-34 year olds
What are main Aetiological factors ? 7
- HPV Virus
- increases with more sexual partners
- Early age sexual intercourse
- Smoking
- Oral contraceptives (possibly due to hormonal disruption or increased sexual partners)
- Genetic component for SCC
- more likely if had pregnancy
What is the histology for cervical cancer?
90% Squamous cell carcinoma
Less common is ademocarcinomas
What is the staging used for Cervical Cancers?
FIGO Staging
What does CIN mean?
Cervical Intraepithelial neoplasia = considered “pre-invasive carcinoma” the tumour is confined to the surface epithelium cells
Graded CIN1/2/3 depending on degree of cell differentiation.
what is CIN III sometimes referred as?
Carcinoma in Situ or severe Dysplasia
What is stage 1 of cervical cancer?
Carcinoma strictly confined to cervix
what is stage 2 of cervical cancer
Carcinoma extends beyond the cervix, but does not extend into pelvic call (involved the vagina but not the lower third)
What is stage 3 of cervical cancer?
Carcinoma has extended into the pelvic sidewall. Tumour involves lower third of vagina. *all cases with hydronephrosis/non-functioning kidney are stage 3
What is stage 4 cancer?
Cancer that has extended beyond the true pelvis and involves mucosa of bladder/rectum
What are the 3 main treatment types?
- Surgery
- Radiotherapy (EBRT+/ BRACHYTHERAPY)
-chemotherapy
What are the main symptoms ?
Intermenstrual bleeding
Post-coital bleeding
Post menopausal bleeding
Unusual discharge
Pelvic pain
*advanced disease: lymphoedema // problems voiding bowels and emptying bladder // Haematuria
What are the clinical investigations?
Full blood count
Chest X-ray
Cervical biopsy
CT
PET
MRI
What would you conduct a blood test as an investigation?
To check for anaemia and also look at the liver and kidney functions.
Why would you conduct a chest X-ray?
To check for metastatic spread to the lungs
Why would a biopsy and a swab be taken if there is discharge?
To diagnose the malignancy histology and check for infection
Why is CT/MRI/PET used in diagnosing cervical disease?
To scan the abdomen and pelvis to assess the local extent of tumour and lymphatic involvement.
What are the routes of spread?
Vaginal vault // uterus // bladder//bowel // kidney // liver // lungs
Which lymphatic nodes are involved?
- Internal Illiac Nodes
- External Illiac nodes
- inguinal nodes (sup and deep)
- obrurator nodes
- presacral nodes
- common Illiac nodes
- aortic nodes
What factors does the treatment management depend on?
- Type of cancer
- stage of cancer
- grade of cancer
- general health of patient
- patient preference
What treatment would a women receive if they had CIS?
Treatments aim to remove abnormal cells
- LLETZ (Large loop exercising of the transformation zone.
- laser therapy/ablation
- cone biopsy
- Hysterectomy (if an older women)
*leaves cervix complete - suitable for women who wish to have children in the future.
What is the maximum size a tumour needs to be for LLETZ procedure?
2cm or less - this is due to removing the surface layer of the cervix and keeping the remainder in tact
How is stage 1 cervical cancer treated?
- Hysterectomy or radical vaginal trachelectomy
Radiotherapy - if stage 1b2 - chemo radiation suggested
What is vaginal trachelectomy?
Surgery to remove the cervix, nearby tissue and upper part of vagina
