Surgery Cervix

Question 1

2nd most frequent cancer among women in the ph

Answer 1

cervical ca

Question 2

t/f cervical ca has poor prognosis

Answer 2

true

Question 3

first necessary cause of human cancer

Answer 3

hpv dna in cervical neoplasia

Question 4

transmission of hpv

Answer 4

• skin to skin genital contact

- ~50% of sexually active women will be infected with oncogenic HPV

Question 5

most oncogenic hpv types

Answer 5

16 and 18, 45 and 31

ph: 16, 18, 45, 51, and 52

Question 6

natural history of hpv to cancer

Answer 6

<30 yo = clear the infection

>30 yo = infection persists, can develop into pre-malignant condition and cervical ca

Question 7

risk factors for hpv

Answer 7

• parity of more/= 7
• ocp use
• smoking
• early coitus
• multiple partners
• early age of 1st full term pregnancy
• co infections + HIV

Question 8

signs and symptoms of cervical ca

Answer 8

• vaginal bleeding
• foul smelling watery, bloody vaginal discharge (late)
• pelvic pain or pain during intercourse (late)

Question 9

diagnosis of cervical ca

Answer 9

• speculum exam
• pelvic exam+ punch biopsy
• cervical punch biopsy

Question 10

most common type of cervical ca

Answer 10

squaca

• exophytic type of growth
• cauliflower like lesions growing outward

Question 11

what is cervical adenoca

Answer 11

• bulky/barrel shaped cervix (cervix is big and mass inside the os)
• endophytic (grows inward)

Question 12

previous method for staging

Answer 12

clinical: bimanual exam of the pelvis, including palpation of uterus and ovaries; rectovaginal exam

Question 13

figo staging of cervical ca

Answer 13

• clinical assessment, imaging, patho findings

Question 14

stage Ia1 and Ia2

Answer 14

• microscopic
• maximum depth less/= 5 mm
  Ia1 = = 3 mm
  Ia2 = = 5mm

Question 15

stage Ib1

Answer 15

• still in cervix
• palpable and visual
• > 5 mm depth of stromal invasion, = 2 cm in greatest dimension

Question 16

stage Ib2 and Ib3

Answer 16

STILL IN CERVIX

Ib2: > 2 cm and = 4 cm, can be measured clinically, imaging, or pathology

Ib3: >4 cm

Question 17

IIa1 and IIa2

Answer 17

• upper vagina
  IIa1: = 4 cm
  IIa2: > 4 cm

Question 18

IIb

Answer 18

• with parametrial involvement but not up to the pelvic wall
• mri > ct
• IIBr = clinically confined to cervix, but see parametrial involvement in mri

Question 19

stage III

Answer 19

IIIa = lower third of vagina, no extension to pelvic wall
IIIb = extension to pelvic wall and/or hydronephrosis or nonfunctioning kidney
IIIc1 = pelvic ln
IIIc2 = paraaortic ln

Question 20

stage IV

Answer 20

IVa = growth to adjacent organs
IVb = other parts of the body

Question 21

t/f it is recommended that the method for imaging, pathological technique used, and results should be recorded

Answer 21

true

Question 22

t/f when in doubt, assign the higher stage

Answer 22

false, lower stage

Question 23

in staging r means __ and p means ___

Answer 23

r = staged according to radio
p = staged according to patho

Question 24

indication for concurrent chemo/radio

Answer 24

• all stages, this is the standard of care

Question 25

indication for radical hysterectomy

Answer 25

• early stage disease (IA, IB1, IB2, IIA non bulky)

- total hysterectomy + surgical removal of the left and right parametrium up to the pelvic side wall up to upper vagina

Question 26

management for early stage cervical ca (stage I-IIA)

Answer 26

radical hysterectomy + concurrent chemorad/rad

Question 27

management for late stage cervical ca (stage II-IV)

Answer 27

duration: 3-4 mos

1st phase:

• pelvic radiation to decrease lateral tumor size
• chemo (cisplatin)

2nd phase

• for central tumor
• brachy (effective upto stage IIIB)

Question 28

primary prevention for cervical ca

Answer 28

• total abstinence
• lifetime monogamy
• delay in onset of sexual intercourse
• use barrier contraceptives
• prompt and adequate treatment of stds and cin
• hpv vaccine

Question 29

secondary prevention for cervical ca

Answer 29

papsmear for >/= 21 yo

hpv test for >/= 30 yo