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Cervical Cancer > ONCOLOGY MANAGEMENT > Flashcards

ONCOLOGY MANAGEMENT Flashcards

1
Q

What are main Epidemiology of Cervical Cancer

A
  • 14th Most common in UK
  • More common in White and Black females
  • Highest Incidence in 30-34 year olds
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2
Q

What are main Aetiological factors ? 7

A
  • 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
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3
Q

What is the histology for cervical cancer?

A

90% Squamous cell carcinoma
Less common is ademocarcinomas

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4
Q

What is the staging used for Cervical Cancers?

A

FIGO Staging

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5
Q

What does CIN mean?

A

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.

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6
Q

what is CIN III sometimes referred as?

A

Carcinoma in Situ or severe Dysplasia

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7
Q

What is stage 1 of cervical cancer?

A

Carcinoma strictly confined to cervix

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8
Q

what is stage 2 of cervical cancer

A

Carcinoma extends beyond the cervix, but does not extend into pelvic call (involved the vagina but not the lower third)

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9
Q

What is stage 3 of cervical cancer?

A

Carcinoma has extended into the pelvic sidewall. Tumour involves lower third of vagina. *all cases with hydronephrosis/non-functioning kidney are stage 3

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10
Q

What is stage 4 cancer?

A

Cancer that has extended beyond the true pelvis and involves mucosa of bladder/rectum

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11
Q

What are the 3 main treatment types?

A
  • Surgery
  • Radiotherapy (EBRT+/ BRACHYTHERAPY)
    -chemotherapy
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12
Q

What are the main symptoms ?

A

Intermenstrual bleeding
Post-coital bleeding
Post menopausal bleeding
Unusual discharge
Pelvic pain

*advanced disease: lymphoedema // problems voiding bowels and emptying bladder // Haematuria

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13
Q

What are the clinical investigations?

A

Full blood count
Chest X-ray
Cervical biopsy
CT
PET
MRI

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14
Q

What would you conduct a blood test as an investigation?

A

To check for anaemia and also look at the liver and kidney functions.

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15
Q

Why would you conduct a chest X-ray?

A

To check for metastatic spread to the lungs

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16
Q

Why would a biopsy and a swab be taken if there is discharge?

A

To diagnose the malignancy histology and check for infection

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17
Q

Why is CT/MRI/PET used in diagnosing cervical disease?

A

To scan the abdomen and pelvis to assess the local extent of tumour and lymphatic involvement.

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18
Q

What are the routes of spread?

A

Vaginal vault // uterus // bladder//bowel // kidney // liver // lungs

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19
Q

Which lymphatic nodes are involved?

A
  • Internal Illiac Nodes
  • External Illiac nodes
  • inguinal nodes (sup and deep)
  • obrurator nodes
  • presacral nodes
  • common Illiac nodes
  • aortic nodes
20
Q

What factors does the treatment management depend on?

A
  • Type of cancer
  • stage of cancer
  • grade of cancer
  • general health of patient
  • patient preference
21
Q

What treatment would a women receive if they had CIS?

A

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.

22
Q

What is the maximum size a tumour needs to be for LLETZ procedure?

A

2cm or less - this is due to removing the surface layer of the cervix and keeping the remainder in tact

23
Q

How is stage 1 cervical cancer treated?

A
  • Hysterectomy or radical vaginal trachelectomy
    Radiotherapy
  • if stage 1b2 - chemo radiation suggested
24
Q

What is vaginal trachelectomy?

A

Surgery to remove the cervix, nearby tissue and upper part of vagina

25
Q

How is stage 2a cancer treated

A

This is normally treated with surgery or chemo radiation

26
Q

How is stage 2b cancer treated?

A

Chemo radiation

27
Q

How is stage 3 treated?

A

Chemoradiation

28
Q

How is stage 4 treated?

A

Surgery
Radiotherapy
Chemotherapy
OR A COMBINATION OF ALL 3

29
Q

What is the prognosis for Stage IA1?

A

100%!!

30
Q

What is prognosis for stage IB2 - IIB?

A

50-70%

31
Q

What is prognosis for stage III ?

A

30-50%

32
Q

What is prognosis for stage IV?

A

5-15%

33
Q

Why is prognosis worse for patients with cervical adenocarcinoma?

A

The adenocarcinoma grow inside cervical cancel and may establish a large tumour volume and detected late as doesn’t show up on smear test.

34
Q

What are the long term complications for cervical cancer? (9)

A
  • Psychological distress
  • Guilt (not attending screening)
  • Sexual problems
  • lymphoedema
  • fertility issues
  • menopause
  • fatigue
  • bowel difficulties
  • bladder difficulties
35
Q

Why is hormone therapy not used?

A

Cervical cancer is not hormone dependant therefore it would not respond to Hormone therapy.

*HRT may be given to younger women following radical treatment.

36
Q

What is hydronephrosis?

A

Condition where kidneys become swollen due to build up of urine

37
Q

What is the GTV?

A

Primary Tumour

38
Q

What is the CTV?

A

2 CTV’S for cervix

CTV T (tumour) - Primary tumour plus spread, include CERVIX, UTERUS, PARAMETRIAL TISSUES, UPPER VAGINA, PROXIMNAL BROAD AND UTERO-SACRAL LIGAMENTS. = 1-1.5cm between GTV and CTV

CTV N (Nodes) - Potential nodal spread, Obturator, internal and external, common illiac, upper pre sacral nodes
Scan with contrast - 7mm margin

39
Q

What is the PTV?

A

CTV T = 15-20MM
CTV N = 7-10MM

IMPORTANT TO REMEMBER THIS IS DIFFERENT

40
Q

On forward planning how many beams?

A

4:
ANT
POST
LEFT LATERAL
RIGHT LATERAL

41
Q

Why do you down weight the post field beam?

A

To minimise the dose to the rectum

42
Q

What are the prescriptions for EBRT?

A

45 - 50.5 GY in 25-28

43
Q

What is the Brachytherapy Boost prescription?

A

8-11Gy in 2 fractions

44
Q

What are the border parameters?

A

Lateral - 1CM outside bony pelvic side walls
Anterior - 3CM of 5th lumbar
Posterior - 2CM anterior to posterior aspect of sacral hollow

45
Q

What beam modifications are used for Cervix

A

Wedges - may be used on lateral fields depending on size of patient and curvature.

Cervical Cancer (1 decks)

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