4 - Gynae - The Cervix and its disorders - Carcinoma of the Cervix Flashcards Preview

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Flashcards in 4 - Gynae - The Cervix and its disorders - Carcinoma of the Cervix Deck (11):
1

what are the two peak ages? when are most cases? incidence is falling, why?

30 + 80
25-49
due to screening

2

pathology - 90% are ? 10% are? from ? epithelium. 2 points about 10% type?

SCC
adenocas from columnar
worse prog and increasing relative to SCCs

3

aetiology - virus? trans? causes what? how to prevent? what incr risk? what about a FHx?

HPV
sex
CIN
vaccine HPV 16 + 18 to all girls pre sexually
smoking, COCP, immunosuppression

not familial

4

Clinical features:
-occult? diagnosis by?
-clinical ca - 4 parts of a classic Hx? what about Ex?

occult - aSx diagnosis by biopsy/LLETZ
clinical Ca - smears missed, PCB, offensive discharge, IMB/PMB common
ulcer/mass may be visible/palpable on cervix

5

Clinical features - what happens in later disease? to cause what?

invasion of ureters, bladder, rectum, and nerves > uraemia, haematuria, rectal bleeding + PAIN

6

staging - describe 4 stages

1 cervix and uterus (ai <3mm depth, <7mm across) (aii) <5m depth, <7mm across) (1b - the rest)
2 upper vagina also (a not parametrium, b in parametrium)
3 lower vagina or pelvic wall, or ureteric obstruction
4 into bladder or rectum, or beyond pelvis

7

Ix - biopsy to ? what used to assess size and invasion to stage disease? what used to show bladder invasion and what used to show size/spread and LN inv? what to assess pt fitness for trt? also??

confirm diagnosis
VE and DRE under anaesthesia unless clearly small
bladder - cystoscopy
MRI for size/spread/LNs
FBC, U+E, CXR
cross match

8

Prognosis depends on ? ? + ?
overall 5y survival? patient reviewed how often?

LN inv, clinical stage and histo grading

65%

3 nd 6m then every 6m for 5y

9

TRT
-1ai?
-1aii-1bi?

-cone biopsy or simple hysterectomy
-lapscop lymphadenectomy (to confirm -ve LNs) and radical trachelectomy to preserve fertility

10

TRT
-1aii-2a
-2b-4

LNs neg? - wertheim's hysterectomy or CTx/RTx
LNs pos? - CTx/RTx with no surgery

CTx/RTx with no surgery

11

poor prog indicators? death how?

death - uraemia due to ureteric obstruction

LNs +ve
advanced stage
large 1' tumour
poorly diff tumour and early recurrence

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