Cervical Cancer

Question 1

Stage 1A1 cervical cancer

Answer 1

Microscopic stromal invasion = 3 mm in depth

Question 2

Stage 1A2 cervical cancer

Answer 2

Microscopic stromal invasion >3mm =5mm in depth

Question 3

Stage 1B1cervical cancer

Answer 3

Macroscopic lesion limited to cervix

Invasion >5mm depth
=2cm dimension

Question 4

Stage 1B2 cervical ca

Answer 4

Dimension >2cm and =4cm

Question 5

Stage 1B3 cervical cancer

Answer 5

Dimension >4cm

Question 6

Stage 2A1cervical ca

Answer 6

Upper 2/3 vagina without parametric

= 4cm

Question 7

Stage 2A2 cervical ca

Answer 7

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

Question 8

Stage 2B cervical ca

Answer 8

Paramatrium involved but not pelvic side wall

Question 9

Stage 3A1 cervical ca

Answer 9

Lower 1/3 of vagina , no pelvic side wall

Question 10

Stage 3B cervical ca

Answer 10

Pelvic side wall +/- hydronephosis or non functioning kidney

Question 11

Stage 3C1cervical ca

Answer 11

Pelvic nodes involved

Question 12

Stage 3C2 cervical ca

Answer 12

Para aortic nodes involved

Question 13

Stage 4A cervical ca

Answer 13

Spread to bladder or rectal mucosa

Question 14

Stage 4B cervical ca

Answer 14

Distant metastasis

Question 15

What cancers type has metastasis to the ovary

Answer 15

Adenocarcinoma

Question 16

Treatment of stage 1A1 cervical cancer

Answer 16

• 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

Question 17

Stage 1A2 treatment cervix

Answer 17

Fertility desires: conization or trachelectomy

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

Lymph node dissection up to inferior mesenteric

Question 18

Stage 1B1 TX cervix

Answer 18

Fertility desires: radical trachelectomy + PLND

No fertility: Type C radical + PLND

Question 19

Stage 1B2 and 2A1 TX cervix

Answer 19

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

Question 20

Stage 1B3 and 2A2 TX cervix

Answer 20

Not surgical candidates

• pelvic EBRT + Plat chemo + brachytherapy

If radiotherapy not available

• radical hysterectomy + LND

Question 21

What was the LACC trial

Answer 21

Evaluation of minimally invasive surgery vs open for cervical cancer

Findings
- shorter overall survival eith minimal approach

Question 22

Treatment of stage 2B and above cervix

Answer 22

• primary chemoradiotherapy

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

Question 23

Management of ASCUS (<25yrs)

Answer 23

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

Question 24

Management of ASCUS >25YRS

Answer 24

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

Question 25

LSIL management

Answer 25

<25yrs :Repeat in 12 months >25yrs: colposcopy

Question 26

HSIL

Answer 26

Colposcopy

Question 27

ASC-H

Answer 27

Colposcopy

Question 28

AGS

Answer 28

Colposcopy + ECC Endometrial sampling is high risk or >35years

Question 29

Unsatisfactory smear

Answer 29

X1 : repeat in 2-4mnths X2 : colposcopy If >25 and hpv pos: repeat or colposcopy

Question 30

Negative smear, absent TZ

Answer 30

Routine screening Hpv testing preferred if >25 yrs

Question 31

Management of CIN1

Answer 31

<25 Years -Preceeding smear : ASC-H/HSIL= observation - colpsocopy and cytology yearly for 2 years

Question 32

Progression risk of CIN1

Answer 32

HSIL- CIN1- CIN3+ = 3.9% ASC-H - CIN1- CIN3+= 1.4%

Question 33

CIN 1 management >25 yrs

Answer 33

Preceeding pap -HSIL: excisional treatment -ASC-H: HPV testing 1 and 2 yrs Negative- routine screening Pos colposcopy Treat if persistent

Question 34

CIN 2 <25 yrs

Answer 34

Observation Colposcopy and cytology 6mnths 1year 2 year

Question 35

CIN 2 >25yrs

Answer 35

Treatment Followup 6mnths 1 year 2 years

Question 36

CIN 2 in pregnancy

Answer 36

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

Question 37

Progression of CIN2

Answer 37

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

Question 38

CIN 3 treatment

Answer 38

Treatment for both age groups Follow up - hpv testing 6mthn 1year 2year If all neg - 3yearly x 25yrs

Question 39

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

Answer 39

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

Question 40

What age is the vaccine ideally targeted to

Answer 40

Boys and Girls age 12-13

Question 41

What is the vaccination schedule

Answer 41

Two doses at least 6mnths apart. If immunocomprosided or >15yrs would require 3 doses 2nd dose 1mnth after 1st 3rd dose 3mnths after 2nd