Week 6 - Day 1 - Oncology Tutorial (Cervical, Endometrial Cancers) Flashcards
- With reference to the information above plus the pathology and CT/MRI reports what is the stage and grade of this cancer?
Dont have the information of the scans an biopsy for grading the cancer sadly
Staging: As the tumour is 4cm in the greatest dimension, extension into the parametrium is negative (cystocscopy is also negative so no extension into the bladder)
Stage - Stage IIA1 (extends into the upper two thirds of vagina =4cm in greatest dimension)
- What cancer treatment modalities are available ? Which do you think will be appropriate for this cancer and why?
- Cone biopsy - for Stage IA1 cancers
- Chemoradiation is the gold standard for advanced cancers
- Radical hystercetomy with lymphadenectomy
For this patient either radical hysterecotmy with ly,phadenectomy (Stage IIA1 is the cut of where radical is preferred to chemo so up to consultant choice) or chemoradiation is likely
- Do you think treatment will be given with curative intent or will treatment be palliative? Why?
The is patient will be given treatment with curative intent Palliative is only if chemo or radio is not appropriate due to advanced stage or patients request / poor general condition of the patient
- She asks if the cancer ‘can be treated’? How should you respond to this question.? What is the prognosis?
Can tell her about the treatment option regarding the treatment and give her some facts based upon 5 year survival rates
- Is this a typical presentation of cervical cancer?
The symptoms of cervical cancer aren’t always obvious, and it may not cause any symptoms at all until it’s reached an advanced stage. This is why it’s very important that you attend all of your cervical screening appointments. In most cases, vaginal bleeding is the first noticeable symptom of cervical cancer. It usually occurs after having sex.
- What is the differential diagnosis of irregular bleeding in a 48 year old woman?
Endometriosis Cervicitis Endometrial cancer Cervical cancer Fibroids
- What may have been the barriers to a. Pelvic examination b. A cervical smear test
Pelvic examination - the women had a tight introitus which may have made vaginal/pelvic examiantion difficult The womens adherence to getting cervical smears carried out
- Would this cancer have been prevented by a. HPV vaccination b. Regular smear tests
HPV vaccination (over 99% of Cervica cancers HPV related) - greatly reduces the risk of cervical cancers as protects agaisnt HPV types 16 and 18 which account for 70% of HPV cancers Regular smear tests - as it takes 6months-3years for HPV infection to high grade CIN then 5 years to 20years for high grade CIN to invasive cervical cancer, screening would have reduced the cancer risk as it could have picked up on the disease whilst still pre inavasive
Current guidelines suggest PET – CT rather than CT staging for cervical cancer stage 1B and above. What do you think may be the benefits and disadvantages of PET-CT compared to traditional CT?
Benefits - PET-CT combined is emerging as the most accurate method for detection of nodal metastases in the pelvis and para-aortic nodes - with sensitivities of 75% and 100% respectively. Disadvantages – can be false positive for infection/inflammation , cost
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MRI is important for radiological staging
PET-CT scan has emerging evidence as most accurate radiological staging for cervical cancer stage 1B and above
How can the endometrial the tumour cells be analysed to determine the grade?
Endometrial biopsy Dilatation and curettage Hysteroscopy
What does it mean that the women is grade 1 stage 1a?
Grade 1 means the cancer is well differentiated - positive prognostic factor Stage 1a - this means the cancer is confined to the endometrium or has invaded <50% of the myometrium
What is the usual treatment for endometrial cancer?
The usual treatment would be hysterectomy with bilateral salpingo-oopherectomy Followed up by radiation if stage 1or2 disease Followed up by chemotherapy - offered for stage 3or4 cancer
what might be the challenges in delivering this treatment for this patient? The hysterectomy with bilateral salpingo-oopherectomy
It might be a challenge due to the patient being morbidly obese - Usually abdominal hysterectomy (laparotomy) would be used but in a patient with a BMI of 44.6 this may prove very difficult
What is the usual prognosis for a grade 1 endometrial cancer? 5 What other issues should be addressed when following up th
Usual prognosis for grade 1 endometrial cancer is 75-95% 5 year survival rate Patient should be advised to lose weight -obesity is a strong risk factor for endometrial cancer She should be followed up 3-6months for 2 years and then annually ther
