Tx for cervical ca Flashcards
Simple hysterectomy what stage ca
1A1
Radical hysterectomy what stage ca
- En-bloc removal of uterus, cervix, parametrial tissues and upper vagina. It is usually combined with pelvic lymphadenectomy
- FIGO IB1
- RH is not recommended if the tumour measures more than 4 cm to reduce the likelihood of using chemoradiotherapy post-surgery
% lymphnode involvement in IB
16 %
% lymphnode involvement in IB if
6 %
% lymphnode involvement in IB > 4 cm
- 36 %
- Should have neo adjuvant chemo
Simple hysterectomy and lymphadenectomy what stage
1A2
Radical trachelectomy
- Vaginal resection of the cervix, the upper 1 to
2 cm of the vaginal cuff and the medial portions of the cardinal and uterosacral ligaments
-The cervix is transected at the lower uterine segment and a prophylactic cerclage is placed at the
time of surgery - The tumour diameter is no greater than 2 cm and there is no evidence of LVSI
- Must be combined with pelvic lymph node dissection for IA2 and IB1 disease
Pregnancy after trachelectomy
- The majority of women can anticipate conceiving spontaneously and delivering near term
- The rate of first and second trimester miscarriage is comparable to that in the general population
- The pre-term delivery rate was slightly higher than
in the general population at 16% compared to 12%
Cold knife conization / LLETZ
Women with early stage disease and no LVSI (FIGO IA2 and microscopic IB1) requesting fertility conservation may be offered cold knife conisation or LLETZ combined with pelvic lymph node dissection
Laparoscopic radical vaginal hysterectomy
- For the treatment of FIGO IB1 disease
appears to be a safe and effective alternative to conventional abdominal RH - Laparoscopic-vaginal radical hysterectomy should not be offered to patients with tumour diameter greater than 2 cm
Chemotherapy for cervical ca
- FIGO IB2, IIA, IIB, IIIA, IIIB and IVA
- Surgery is not offered to this group of women because of the significant risk of positive margins and positive nodes
- Concurrent chemoradiation is better than radiation alone
- Overall survival benefit for treatment with chemoradiation compared to radiation alone. Survival
is increased from 40% to 52% - Patients who have undergone surgery for cervical carcinoma and have positive nodes should be considered for adjuvant treatment with concurrent chemoradiotherapy with platinum based chemotherapy
Patients who will benefit from radio even if neg lymph nodes
- Invasion of more than a third of the total cervical stromal volume
- LVSI
- Tumour diameter of >4 cm
Brachytherapy when
Brachytherapy should be considered an essential component of radical radiotherapy or chemoradiotherapy
