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DM 2 - Gynecology > Cervical Cancer > Flashcards

Cervical Cancer Flashcards

1
Q

Stage 1A1 cervical cancer

A

Microscopic stromal invasion = 3 mm in depth

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2
Q

Stage 1A2 cervical cancer

A

Microscopic stromal invasion >3mm =5mm in depth

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3
Q

Stage 1B1cervical cancer

A

Macroscopic lesion limited to cervix

Invasion >5mm depth
=2cm dimension

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4
Q

Stage 1B2 cervical ca

A

Dimension >2cm and =4cm

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5
Q

Stage 1B3 cervical cancer

A

Dimension >4cm

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6
Q

Stage 2A1cervical ca

A

Upper 2/3 vagina without parametric

= 4cm

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7
Q

Stage 2A2 cervical ca

A

Upper 2/3 vagina , no parametrium
>4cm dimension

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8
Q

Stage 2B cervical ca

A

Paramatrium involved but not pelvic side wall

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9
Q

Stage 3A1 cervical ca

A

Lower 1/3 of vagina , no pelvic side wall

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10
Q

Stage 3B cervical ca

A

Pelvic side wall +/- hydronephosis or non functioning kidney

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11
Q

Stage 3C1cervical ca

A

Pelvic nodes involved

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12
Q

Stage 3C2 cervical ca

A

Para aortic nodes involved

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13
Q

Stage 4A cervical ca

A

Spread to bladder or rectal mucosa

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14
Q

Stage 4B cervical ca

A

Distant metastasis

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15
Q

What cancers type has metastasis to the ovary

A

Adenocarcinoma

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16
Q

Treatment of stage 1A1 cervical cancer

A
  • fertility sparing : conization 3mm margin 10mm depth
  • no fertility: extra fascial hysterectomy
  • LVSI:
    A) modified radical hysterectomy + PLND
    B) fertility sparing: trachelectomy/cone biopsy + PLND
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17
Q

Stage 1A2 treatment cervix

A

Fertility desires: conization or trachelectomy

No fertility: type B radical hysterectomy
Or
Pelvic EBRT + brachytherapy

Lymph node dissection up to inferior mesenteric

18
Q

Stage 1B1 TX cervix

A

Fertility desires: radical trachelectomy + PLND

No fertility: Type C radical + PLND

19
Q

Stage 1B2 and 2A1 TX cervix

A
  • Type C radical hysterectomy + PLND
    Or
  • Pelvic EBRT + bracytherapy +/- platinum chemotherapy
20
Q

Stage 1B3 and 2A2 TX cervix

A

Not surgical candidates

  • pelvic EBRT + Plat chemo + brachytherapy

If radiotherapy not available

  • radical hysterectomy + LND
21
Q

What was the LACC trial

A

Evaluation of minimally invasive surgery vs open for cervical cancer

Findings
- shorter overall survival eith minimal approach

22
Q

Treatment of stage 2B and above cervix

A
  • primary chemoradiotherapy

Resource limited
- rad hyste or Neoad chemo followed by rad hyste

23
Q

Management of ASCUS (<25yrs)

A
  • Repeat smear in 12mnths x 2
  • persistent x 2 years: colposcopy
  • triage hpv testing acceptable
24
Q

Management of ASCUS >25YRS

A
  • triage HPV testing
    Pos: colposcopy
    Neg: routine screening
  • repeate in 12mnths acceptable x 1
    (Persistent or worse colpo)
25
Q

LSIL management

A

<25yrs :Repeat in 12 months

> 25yrs: colposcopy

26
Q

HSIL

A

Colposcopy

27
Q

ASC-H

A

Colposcopy

28
Q

AGS

A

Colposcopy + ECC

Endometrial sampling is high risk or >35years

29
Q

Unsatisfactory smear

A

X1 : repeat in 2-4mnths
X2 : colposcopy

If >25 and hpv pos: repeat or colposcopy

30
Q

Negative smear, absent TZ

A

Routine screening

Hpv testing preferred if >25 yrs

31
Q

Management of CIN1

A

<25 Years

-Preceeding smear : ASC-H/HSIL= observation

  • colpsocopy and cytology yearly for 2 years
32
Q

Progression risk of CIN1

A

HSIL- CIN1- CIN3+ = 3.9%

ASC-H - CIN1- CIN3+= 1.4%

33
Q

CIN 1 management >25 yrs

A

Preceeding pap
-HSIL: excisional treatment

-ASC-H: HPV testing 1 and 2 yrs
Negative- routine screening
Pos colposcopy
Treat if persistent

34
Q

CIN 2 <25 yrs

A

Observation

Colposcopy and cytology 6mnths 1year 2 year

35
Q

CIN 2 >25yrs

A

Treatment
Followup
6mnths 1 year 2 years

36
Q

CIN 2 in pregnancy

A

Surveillance testing

Colpsocopy , cytology +/- hpv every 12 - 24 weeks

37
Q

Progression of CIN2

A

50% regress (60% if <30)
30% persist
20% progress to CIN 3+

38
Q

CIN 3 treatment

A

Treatment for both age groups

Follow up
- hpv testing 6mthn 1year 2year
If all neg
- 3yearly x 25yrs

39
Q

What is are the different types of hpv vaccines and what do they cover

A

1) cervarix: bivalent vaccine covered hpv 16,18

2) gardasil: quadravalent covers 6,11,16,18

3) gardasil 9: nonavalent covers 6,11,16,18,31,33,45,52,58

40
Q

What age is the vaccine ideally targeted to

A

Boys and Girls age 12-13

41
Q

What is the vaccination schedule

A

Two doses at least 6mnths apart.

If immunocomprosided or >15yrs would require 3 doses

2nd dose 1mnth after 1st
3rd dose 3mnths after 2nd

DM 2 - Gynecology (22 decks)

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