Flashcards in 4 - Gynae - The Cervix and its disorders - Carcinoma of the Cervix Deck (11):
what are the two peak ages? when are most cases? incidence is falling, why?
30 + 80
due to screening
pathology - 90% are ? 10% are? from ? epithelium. 2 points about 10% type?
adenocas from columnar
worse prog and increasing relative to SCCs
aetiology - virus? trans? causes what? how to prevent? what incr risk? what about a FHx?
vaccine HPV 16 + 18 to all girls pre sexually
smoking, COCP, immunosuppression
-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
Clinical features - what happens in later disease? to cause what?
invasion of ureters, bladder, rectum, and nerves > uraemia, haematuria, rectal bleeding + PAIN
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
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??
VE and DRE under anaesthesia unless clearly small
bladder - cystoscopy
MRI for size/spread/LNs
FBC, U+E, CXR
Prognosis depends on ? ? + ?
overall 5y survival? patient reviewed how often?
LN inv, clinical stage and histo grading
3 nd 6m then every 6m for 5y
-cone biopsy or simple hysterectomy
-lapscop lymphadenectomy (to confirm -ve LNs) and radical trachelectomy to preserve fertility
LNs neg? - wertheim's hysterectomy or CTx/RTx
LNs pos? - CTx/RTx with no surgery
CTx/RTx with no surgery