Cervix Flashcards
Risk factor for ca cervix
age: 35
Due to hormonal increase
-sexually active woman
-early onset of sexual activity
-early first pregnancy
- multiparity
-OCP
- prenatal exposure of DES
environmental
- low socio economic condition
- mutiple sexual partner
- multiparity
-H/O STD
other:
- IUD use
- dietary factor: obesity, physical factor
- tobacco use
- H/O vulval or vaginal dysplasia , KRAS, PTEN mutation
HPV associated with cancer
16,18 predominant
6,11- wart
so high risk
16,18,31,33,43,45,58
quadrivalent vaccine consists which hpv
6,11,16,18
85% of incidence reduction by vaccine
Complication of radiotherapy in Ca Cx acute
Acute:
GIT: nausea, vomitting, diarrhea, cramping, entero proctitis
Genito urinary: cystitis, urethritis, frequency, nocturia, UTI
Skin: erythema, dry or moist desquamation
Vagina: acute radiation vaginitis, superficial ulceration, severe necrosis,
Late complication of Radiation in carcinoma cervix
Radiation proctitis
Late radiation cystitis
Vaginal stenosis
Ureteral stricture
Recto vaginal, vesio vaginal fistula
Anal incontinence
Femoral neck fracture
Lymphedema if pelvic nodal irradiation
Lumbosacral plexopathy
2nd malignancy
Contraindication of radiotherapy in ca cervix
Associate acute or chronic PID
Pelvic kidney
Associated fibroid uterus, uterine prolapse
Ovarian tumor
Genital fistula
Vaginal stenosis
Recurrence after irradiation
Surgery is preferred in adeno
Important prognostic factor for carcinoma cervix
Status of the lymph node
Size of the primary tumor
Presence or absence of parametrial extension
Depth of stromal extension
Histological cell type
Status of vaginal margins
Treatment in a high volume center
Tumor marker
Microvessels densisity
Obesity
Histopathological classification of ca cervix
Squamous cell carcinoma (keratinizing, non keratinizing) >80%
Adenocarcinoma (endocervial, mucinous)
Clear cell carcinoma
Adenosquaous
Serous carcinoma
Glassy cell
Adenoid cystic
Small cell differentiation
Undifferentiated carcinoma
indication of interstitial brachytherapy
parametrial extension of tumor that cannot be encompassed by standard ICRT
narrow vagina
OS/uterine canal cannot be identified
stump or vault recurrence
contraindication of brachytherapy
prior pelvic RT
medical co morbidity
metastatic disease
poor performance status
severe sepsis/infection
inadequate space
heavy parametrial infiltration of tumor
acute infection
Acute bleeding
OAR of carcinoma cervix radiotherapy
bladder: 2cc: <85-90Gy
rectum/sigmoid: </ 65-75Gy
bone marrow D10: <90%
femoral head <44 Gy
indication of brachytherapy in carcinoma cervix
as a component of definitive EBRT: (IIB and above)
IA patient dont want to do surgery: LNI 0.01%
positive margin, large tumor: in case of post operative RT
endometrial brachytherapy indication
IA1 low grade and favorable histology:endometrioid
fertility preserving surgery can be done upto
IA1, IA2, IB1 , age below 40 years, squamous and adenocarcinoma, below 2 cm
only brachytherapy is indicated in which stage of carcinoma cervix
stage IA1 , with no LVSI
