Cervical Cancer Flashcards
(173 cards)
1
Q
What’s the mc cause of death from female pregnancy worldwide?
A
Cervical Cancer
2
Q
What’s the major RF a/w cervical cancer?
A
HPV 16 and 18
3
Q
What are the lateral structures of cervix?
A
Parametria lie within the broad ligaments and contain ureters (1-2 cm) from the cervix and uterine arteries
4
Q
Which viral proteins are responsible for malignant transformation?
A
E6 and E7
5
Q
which virus may act as co factor ?
A
HSV type 2
6
Q
What are the RFs which increases chances of exposure to HPV?
A
- early onset of sexual activity
- early age at 1st pregnancy
- multiparity
- multiple sexual partners
- smoking and low social class
- smoking and immunocompromised states
- DES: exposure in utero: clear cell carcinoma as in vagina
7
Q
what’s the standard screening technique in England and wales
A
Liquid Based Cytology
replaced Papanicolau smear
8
Q
How does screening guide further managment?
A
Normal: repeat in 3 to 5 years
Inadequate: repeat
Borderline : refer for colposcopy within 4 weeks
CIN1 to CIN 3: Colposcopy
Possible invasion and Glandular invasion: Colposcopy within 2 weeks
9
Q
who can avoid colposcopy following Cervical Screening?
A
HPV test negative
HPV +: immediate colposcopy
10
Q
How can Cervical Cancer be prevented?
A
Quadrivalent Vaccine (HPV 6, 11, 16 and 18)
11
Q
Does vaccination obviate the need for screening? and WHy?
A
No
other viruses can cause
12
Q
How long does it take from CIN to Invasive cancer?
A
10 to 12 years
13
Q
About what % of pts with CIN 3 develop Invasive carcinoma?
A
30%
14
Q
On IHC, how are sq cell carcinoma and Adenocarcinoma differentiated?
A
Reactivity to anti cytokeratin: epithelial origin
ab against mucin: Adenocarcinoma
15
Q
How to distinguish between endocervical and endometrial adenocarcinoma?
A
Endocervical: CEA +, P16 +, HPV +
Endometrial tumors: vimentin +, ER +, PgR +
16
Q
What are s/s of cervical cancer?
A
- Abnormal VAgina bleeding
- Vaginal discharge
- Dyspareunia
17
Q
What does abnormal vaginal bleeding mean?
A
Post coital
intermenstrual
post menopausal
heavy menstrual bleeding with pain/pressure symptoms
18
Q
what are the clinical features of local spread of cervical cancer?
A
- Renal failure due to ureteric obstn
- frequency and dysuria
- pelvic pain
- bladder outflow obstruction
- change in bowel habbit
- rectal bleeding
- hematuria
- urine incontinence (vvf)
- faecal incontinence
- deep pelvic pain and lymphedema of legs
19
Q
How is parametrial invasion best examined?
A
PR
20
Q
What are staging Investigations for cervical cancer?
A
- Cervical Biopsy
- MRI for primary tumor assessment
- CT Chest
- PET CT for locally advanced cervical caner amenable to CRT
21
Q
What test should not be missed in premenopausal women ?
A
Pregnancy test
22
Q
What’s the Rx of St IA1 cervical cancer?
A
Simple Hysterectomy is adequate
Post menopausal : Hysterectomy + BSO
Fertility sparing: Knife cone biopsy
23
Q
What’s the Rx of St IA2 cervical cancer?
A
LN risk: 7.4 %
Mod Rad Hysterectomy and LND
Fertility sparing: RAdical tracheloectomy
Medically unfit or pt who decline: RT RAdical
24
Q
What’s the Rx of St IB1 and small volume st IIA cervical cancer?
A
Surgery or RT
25
Which structures are removed in radical Wertheim hysterectomy?
Uterus, upper third vagina and entire parametrium and B/L Lymphadenectomy
Preserve ovary if premenopausal
Fertility sparing: Radical Vaginal Trachelectomy and laparoscopic Lymphadenectomy
26
What's the Rx of St IB2 to IVA cervical cancer?
CRT followed by Brachy
No conc chemo for unfit pts
27
What's the Rx of St IVB cervical cancer?
Palliative Rx (chemo, RT, and surgery)
28
What's the Rx for recurrent cervical cancer?
Central Pelvic Recurrence:
following CRT: Surgery
isolated mets as regional LN: SBRT
29
What are the four level defined by RCR for IGBT?
1. verification of applicator position
2. accurate definition of OAR doses
3. Conformation of dose distribution
4. Dose escalation
30
What should be the minimum equivalent (2 Gy/#) to HRCTV?
75 to 80 Gy
31
What should be included in HRCTV?
All residual macroscopic tumor, whole cervix and presumed extracervical tumor (grey zones on MRI)
32
what tolerances are taken for rectum, sigmoid/bowel and Bladder?
alpha/beta: 3,
rectum 70 to 75 Gy
Sigmoid/bowel 70 to 75 Gy
Bladder 90 - 95 Gy
33
what are advantages of HDR BT over LDR BT?
1. patient convenience
2. reduced treatment time
3. radiation protection and machine availability
34
what's current recommended dose for EBRT in UK for cervical cancer?
45 Gy/ 25#
50.4 Gy/ 28#
35
what's the BT dose?
21 Gy/ 3 sessions
others; 14 Gy/ 2 sessions
36
what are conventional field borders for Cervical CAncer RT ?
As in Endometrial cancer
37
How is image verification done for RT ?
1st 3 days CBCT or portal beam and then weekly
38
What chemo, at what dose and when should be given with RT
Cisplatin 40 mg/m2 weekly , 1 hour prior to RT
39
when should cisplatin not be given?
poor renal function or poor PS
40
what is definition of pt A ?
Manchester system
2 cm above the lateral vaginal fornixes and 2 cm lateral to central uterine tube
41
what is pt B?
5 cm lateral to midline
42
what is ICRU 38 bladder point?
posterior surface of bladder balloon
43
What is rectal point?
5 mm behind the postr vaginal wall at the level of lower end of the intrauterine source
44
What are the indications of adjuvant CRT in cervical cancer?
1. positive LN
2. Positive margin
3. positive parametria
45
what are the systemic treatment options for Cervical Cancer? (NCCN 2025)
* PD-L1–positive tumors
Pembrolizumab + cisplatin/paclitaxel
± bevacizumab (category 1)e,f,i,7
Pembrolizumab + carboplatin/paclitaxel
± bevacizumab (category 1)e,f,i,7
* Cisplatin/paclitaxel/bevacizumabe,8
(category 1)
* Carboplatin/paclitaxel/bevacizumabe
* Atezolizumab + cisplatin/paclitaxel +
bevacizumab (category 1)
* Atezolizumab + carboplatin/paclitaxel +
bevacizumab (category 1)e,
46
what are Concurrent Chemo recommendation as per NCCN (2025)?
Cisplatin + pembrolizumab
category 1: FIGO 2014 Stage IIIA, IIIB, and IVA
category 2B: select FIGO 2018 stage III–IVA
* Carboplatin + pembrolizumab
if cisplatin intolerant
category 1: FIGO 2014 Stage IIIA, IIIB, and IVA
category 2B: select FIGO 2018 stage III–IVA
* Cisplatin
* Carboplatin if cisplatin intolerant
47
How to manage Cervical cancer during pregnancy?
1st and 2nd trimester: termination of pregnancy followed by Rx
3rd : Wait for Birth: CS and Hysterectomy
48
How is SCLC cervix treated?
Chemo as in SCLC followed by RT
Surgery for few pts with small volume
49
what are the prognostic factors for cervical cancer?
Tumor Related
Patient Related
Treatment related
50
what are the tumor related prognostic factors for cervical cancer?
1. increased tumor bulk
2. LN +
3. LVSI +
4. higher stages
5. Adenocarcinoma
51
what are the Patient related prognostic factors for cervical cancer?
1. anemia
2. smoking
3. PS poor
52
what are the treatment prognostic factors for cervical cancer?
1. + margin
2. long duration of RT treatment
3. no ICBT
53
What are approx 5 yrs survival for Cervical cancer pts, stage wise?
IA: 100 %
IB: 80 to 95 %
II: 60 to 90 %
III: 30 to 50 %
IV: 5 to 20 %
54
55
How many women are diagnosed with cervical cancer worldwide each year?
520,000 women
## Footnote
This statistic highlights the global impact of cervical cancer.
56
What percentage of female cancer diagnoses in the UK does cervical cancer represent?
2%
## Footnote
This percentage indicates the prevalence of cervical cancer among all female cancer cases in the UK.
57
What is the lifetime risk of developing cervical cancer in the UK?
1 in 116
## Footnote
This statistic reflects the likelihood of women in the UK developing cervical cancer over their lifetime.
58
List some risk factors implicated in the development of cervical cancer.
* Sexual activity under the age of 20
* Smoking
* Immunosuppression
* Infection with sexually transmitted diseases
## Footnote
These factors can contribute to the increased risk of cervical cancer.
59
What is the principal causative agent of cervical cancer?
Human papilloma virus (HPV)
## Footnote
HPV is responsible for the majority of cervical cancer cases, particularly subtypes 16 and 18.
60
Where do most cervical carcinomas arise?
At the squamo-columnar junction of the ectocervix and endocervix
## Footnote
This anatomical location is critical in understanding the development of cervical cancer.
61
What is the progression rate from dysplastic lesions to invasive carcinoma?
Dysplastic lesions undergo spontaneous regression in 25–38%, persist in 50–60%, and progress to invasive cancers in 2–14%
## Footnote
This statistic illustrates the potential outcomes of dysplastic lesions.
62
What types of cancer account for 90–95% of cervical cancers?
* Squamous cell carcinomas
* Adenocarcinomas
## Footnote
These histologic types are the most common forms of cervical cancer.
63
Name three patterns of spread for cervical cancer.
* Locally to the lower uterine segment
* Vagina
* Paracervical spaces
## Footnote
Understanding the patterns of spread is crucial for staging and treatment planning.
64
What are the most frequent sites of distant recurrence for cervical cancer?
* Lung
* Extra pelvic nodes
* Liver
* Bone
## Footnote
These sites are important to monitor for potential metastasis.
65
What is the earliest symptom of invasive cervical cancer?
Abnormal vaginal bleeding, often post-coital
## Footnote
This symptom is critical for early detection of cervical cancer.
66
What triad of symptoms is associated with extensive pelvic wall involvement?
* Sciatic pain
* Leg oedema
* Hydronephrosis
## Footnote
Recognizing this triad can indicate advanced disease progression.
67
What are some symptoms of advanced cervical cancer?
* Haematuria
* Symptoms of a vesicovaginal fistula
* Cachexia
* Cough
* Jaundice
* Left supraclavicular nodal mass
## Footnote
These symptoms may indicate late-stage disease or metastasis.
68
What is included in the pretreatment evaluation for cervical cancer?
* Examination under anaesthesia (EUA)
* FBC and biochemistry to exclude anaemia and renal impairment
* Biopsy for histological diagnosis
* Chest X-ray
* MRI pelvis
* Cystoscopy/sigmoidoscopy/barium enema/IVU
* PET/CT
* CT scan chest, abdomen, and pelvis for stage IV disease
## Footnote
This comprehensive evaluation helps in accurate diagnosis and treatment planning.
69
70
What factors influence the choice of treatment for cervical cancer?
Tumour size, stage, histology, lymph node involvement, risk factors for complications, patient preference.
## Footnote
These factors help determine the most appropriate treatment approach.
71
What are the treatment options for in situ disease (CIN III)?
Cone biopsy, laser therapy, depending on extent of disease, age of patient, requirement for fertility preservation.
## Footnote
Treatment choices may vary based on individual patient circumstances.
72
What are the treatment options for Stage IA1 cervical cancer without lymphovascular invasion (LVI)?
Cone biopsy or large loop excision of the transformation zone (LLETZ), simple hysterectomy.
## Footnote
Treatment options consider the patient's fertility preservation wishes.
73
How is Stage IA1 cervical cancer with lymphovascular invasion (LVI) managed?
Modified radical hysterectomy with pelvic node dissection, radical trachelectomy with laparoscopic pelvic node dissection if fertility is desired.
## Footnote
Management options are influenced by the presence of LVI.
74
What are the treatment options for Stage IA2 cervical cancer?
Radical hysterectomy (type II) with pelvic node dissection, radical trachelectomy with laparoscopic pelvic node dissection (if tumour <2 cm and no LVI), radiotherapy (brachytherapy alone or with external beam).
## Footnote
Treatment decisions are based on tumour size and patient fertility preferences.
75
What is the 5-year cumulative pregnancy rate for patients undergoing radical trachelectomy for Stage IA2?
52.8% with low cancer recurrence rate.
## Footnote
This approach allows for fertility preservation while managing cervical cancer.
76
What are the treatment options for Stage IB and IIA cervical cancer?
Surgery or radiotherapy, choice depends on age, desire to preserve ovarian function, co-morbid conditions, patient choice.
## Footnote
Both treatments yield similar cure rates for Stage IB squamous carcinoma.
77
List the histopathologic subtypes of cervical cancer.
* Squamous carcinoma: keratinizing, non-keratinizing, verrucous
* Endometrioid adenocarcinoma
* Clear cell adenocarcinoma
* Adenosquamous carcinoma
* Adenoid cystic carcinoma
* Small cell carcinoma
* Undifferentiated carcinoma
## Footnote
Understanding these subtypes is crucial for treatment planning.
78
79
What are the treatment options for Stage IB1 and IIA1 cervical cancer with a tumour size <4 cm?
Radical hysterectomy with bilateral pelvic node dissection or radical radiotherapy.
## Footnote
Treatment choice depends on the specifics of the case.
80
What surgical procedures are involved in the treatment of Stage IB1 and IIA1 cervical cancer?
Removal of the uterus, upper third of vagina, bilateral parametria, uterosacral, utero-vesical ligaments, and bilateral pelvic lymph nodes.
## Footnote
Para-aortic lymph node sampling is indicated if there is clinical suspicion of nodal involvement.
81
What type of radiotherapy is used for Stage IB1 and IIA1 cervical cancer?
External beam pelvic irradiation combined with intracavitary applications delivering 80–85 Gy to point A.
## Footnote
This is a standard treatment approach for the specified stages.
82
What are the treatment options for Stage IB2 and IIA2 cervical cancer with a tumour size >4 cm?
* Radical hysterectomy and bilateral pelvic lymphadenectomy +/- adjuvant therapy
* Concurrent chemoradiation (weekly cisplatin) delivering 85–90 Gy to point A
* Radical radiation therapy when cisplatin is not suitable (PS >2 and GFR <50 ml/min)
## Footnote
Treatment is tailored based on patient condition.
83
When is adjuvant chemoradiation recommended after radical surgery for cervical cancer?
If there are any risk factors such as positive nodes, positive parametria, or close (≤5 mm) or positive surgical margins.
## Footnote
Adjuvant treatment aims to improve survival in high-risk patients.
84
What factors classify patients as intermediate risk in cervical cancer treatment?
* Deep invasion of cervical stroma
* Lympho-vascular space invasion
* Tumour size >4 cm
## Footnote
Intermediate risk patients may benefit from adjuvant whole pelvic irradiation.
85
What does recent meta-analysis suggest about concurrent chemoradiation in cervical cancer?
It improves disease-free survival by an absolute 10% and overall survival by 13%.
## Footnote
This makes concurrent chemoradiotherapy the standard of care for eligible patients.
86
What is the treatment of choice for Stage IIB–IIIB cervical cancer?
Concurrent chemoradiotherapy (weekly cisplatin during EBRT).
## Footnote
A combination of EBRT and brachytherapy delivers specific doses to points A and B.
87
What are the FIGO stages for cervical cancer?
* Stage I: Confined to the cervix
* Stage II: Invades beyond the uterus
* Stage III: Involves lower third of the vagina
* Stage IV: Extended beyond the true pelvis
## Footnote
Staging is crucial for determining treatment options.
88
What defines Stage IA cervical cancer?
Invasive carcinoma diagnosed only by microscopy with stromal invasion of ≤3.0 mm in depth and extension of ≤7.0 mm.
## Footnote
This stage represents very early invasive disease.
89
What treatment options are available for Stage IVA cervical cancer?
* Neo-adjuvant chemotherapy or concurrent chemoradiotherapy
* Pelvic eenteration
* Palliative radiotherapy or chemotherapy
* Best supportive care
## Footnote
Management should be individualized based on patient needs.
90
91
What is a suitable treatment approach for selected patients with good general and renal status not suitable for surgical eenteration?
A radical approach with neo-adjuvant chemotherapy or concurrent chemoradiotherapy
## Footnote
This approach is specifically for patients who cannot undergo surgery.
92
For which patients is surgical eenteration suitable?
Selected stage IV patients
## Footnote
Surgical eenteration is a procedure often considered for advanced cervical cancer cases.
93
What is the aim of radical radiotherapy in cervical cancer?
To deliver 80–90 Gy to point A and 50–60 Gy to point B
## Footnote
Point A and Point B are specific anatomical and dosimetric locations relevant in cervical cancer treatment.
94
What are the definitions of Point A and Point B in cervical cancer radiotherapy?
Point A: 2 cm from central line and 2 cm above ovoids; Point B: 3 cm lateral to Point A
## Footnote
These points are critical for accurate dose delivery during treatment.
95
What is the maximum tolerated dose of pelvic EBRT?
50 Gy in 1.8–2 Gy per fraction
## Footnote
This dosage is important for minimizing side effects while maximizing treatment efficacy.
96
What is the dose reduction for medium dose rate (MDR) brachytherapy?
10% reduction of conventional dose
## Footnote
This adjustment is necessary due to the reduced treatment time when using MDR.
97
What are the indications for radical radiotherapy in cervical cancer?
* Stage IB2–IIA
* Stage IIB–IVA
* Isolated pelvic recurrence after previous surgery
## Footnote
These stages indicate the severity and spread of the disease, influencing treatment decisions.
98
What is the target volume definition for conventional EBRT in cervical cancer?
* Superior: top of L5
* Inferior: lower border of obturator foramen/3 cm below inferior aspect of disease
* Lateral: 1 cm beyond pelvic brim
* Anterior: mid-symphysis pubis
* Posterior: 2 cm anterior to sacral hollow
## Footnote
This definition helps in accurately targeting the cancerous area during treatment.
99
What are the components of GTV, CTV, and PTV in cervical cancer radiotherapy planning?
GTV: primary tumour and enlarged lymph nodes; CTV: primary tumour, uterus, cervix, upper vagina, ovaries, parametria, proximal uterosacral ligament + lymph nodes; PTV: 10–15 mm margin around all CTV
## Footnote
These definitions are crucial for treatment planning and ensuring adequate coverage of the tumor.
100
What is the brachytherapy dose for a tumour <4 cm (Stage IB1)?
30 Gy to point A
## Footnote
This specific dose is tailored for smaller tumors to maximize treatment effectiveness.
101
What is the chemotherapy regimen for patients receiving 50.4 Gy in 28 fractions?
Cisplatin 40 mg/m2 (maximum 70 mg) weekly for 5 weeks
## Footnote
This regimen is often used in conjunction with radiation therapy to enhance treatment outcomes.
102
What treatment may be considered when brachytherapy is not possible?
Additional EBRT (16–20 Gy in 8–10 fractions)
## Footnote
This option is important for maintaining treatment efficacy when brachytherapy cannot be administered.
103
What is the recommended treatment for stage IVA cervical cancer patients?
Palliative treatment (radiotherapy or chemotherapy)
## Footnote
Most stage IVA patients have poor performance status, making palliative care the best option.
104
Is there a standard chemotherapy regimen proven for stage IVB cervical cancer?
False
## Footnote
No standard regimen has been established, making treatment challenging.
105
What is the role of radiation therapy in stage IVB cervical cancer?
Used for palliation of central disease or symptomatic distant metastasis
## Footnote
This use of radiation is focused on alleviating symptoms rather than curing the disease.
106
107
What factors should treatment decisions be based on for recurrence?
Performance status of the patient, site and extent of recurrence and/or metastases, prior treatment.
108
How may relapse in the pelvis following primary surgery be treated?
Radiotherapy or pelvic e-enteration.
109
What is the expected median time to progression or death after recurrence following primary surgery?
Three to seven months.
110
What is the only potentially curative treatment after primary irradiation?
Pelvic e-enteration.
111
What factors improve prognosis for patients selected for pelvic e-enteration?
* Disease-free interval greater than six months
* Recurrence 3 cm or less in diameter
* No sidewall fixation.
112
What is the 5-year survival rate for patients selected for treatment with pelvic e-enteration?
30–60%.
113
What is the operative mortality rate for pelvic e-enteration?
<10%.
114
What is the role of chemotherapy in distant metastasis and recurrent metastatic disease?
Palliative role after failure of surgery or radiotherapy.
115
What is the most active chemotherapy agent for metastatic or recurrent cervical cancer?
Cisplatin.
116
What is the response rate of cisplatin in metastatic cervical cancer?
20–30%.
117
What is the median survival for patients treated with cisplatin?
7 months.
118
What are the 5-year survival rates for stage I cervical cancer based on nodal involvement?
* Node negative: 85–95%
* Node positive: 45–55%.
119
What factors are associated with a poor prognosis in cervical cancer?
* LVSI
* Deep stromal invasion (10 mm or more)
* More than 70% invasion
* Parametrial extension.
120
What is the 5-year survival rate for stage IIB cervical cancer?
66%.
121
What are significant surgical complications associated with cervical cancer treatment?
* Ureterovaginal fistula (<2%)
* Vesicovaginal fistula (<1%).
122
What late sequelae can occur following radiation therapy?
Commonly affect the rectum, bladder, and small bowel.
123
What are palliative care issues in advanced cervical cancer?
* Pelvic pain
* Bleeding
* Bone pain from metastases
* Systemic symptoms.
124
What is a general guideline for follow-up after cervical cancer treatment?
* Clinical evaluation three-monthly for one year
* Four-monthly for one year
* Six-monthly for three years
* Annually thereafter.
125
What is the main goal of screening for cervical cancer?
To reduce the incidence and mortality.
126
Which screening method has been effective in reducing cervical cancer incidence?
Cervical Cytology (Pap Smear) Screening.
127
What is the age range for women receiving the first invitation for cervical screening in the UK?
Aged 25 years.
128
What age group in the UK has 3-yearly cervical screening?
Aged 25–49 years.
129
What is the age range for women in the UK who have 5-yearly cervical screening?
Aged 50–64 years.
130
What has been shown to reduce the number of further pre-invasive lesions and invasive disease?
HPV vaccines.
131
What is the age range for girls in the UK who are vaccinated against HPV?
Aged 12–13.
132
133
What is the aim of radical radiotherapy in cervical cancer?
To deliver 80–90 Gy to point A and 50–60 Gy to point B
134
What does point A represent in cervical cancer radiotherapy?
The point of crossing of uterine artery and ureters, located 2 cm from central line and 2 cm above ovoids
135
What is the maximum tolerated dose of pelvic EBRT?
50 Gy in 1.8–2 Gy per fraction
136
What is the dose reduction for medium dose rate (MDR) brachytherapy?
10% reduction from conventional dose
137
What is the dose reduction for high dose rate (HDR) brachytherapy?
40–45% reduction from conventional dose
138
List the indications for postoperative Chemo radiotherapy in cervical cancer.
* Parametrial involvement
* Positive nodes
* Close or positive margin
139
What stages of cervical cancer are treated with radical radiotherapy?
* Stage IB2–IIA
* Stage IIB–IVA
* Isolated pelvic recurrence after previous surgery
140
Define the superior limit of the conventional target volume for EBRT.
Top of L5
141
Define the inferior limit of the conventional target volume for EBRT.
Lower border of obturator foramen/3 cm below inferior aspect of disease (IIIA disease)
142
What is included in the GTV during CT planning?
Primary tumour and enlarged lymph nodes
143
What does CTV stand for and what does it include?
Clinical Target Volume; includes primary tumour, uterus, cervix, upper vagina, ovaries, parametria, proximal uterosacral ligament + lymph nodes (7–10 mm margin around blood vessels)
144
What is the margin used for PTV around the CTV?
10–15 mm margin around all CTV except for nodal regions and parametria where a 7 mm margin is used
145
What is the EBRT dose for a tumour <4 cm (1B1)?
45 Gy in 25 fractions
146
What is the brachytherapy dose for stage IB2, II, IIIB, IVA and pelvic nodal disease?
27 Gy to point A
147
What is the brachytherapy dose for stage IIIA?
Brachytherapy using line source and dose same as other stages
148
What additional EBRT may be considered when brachytherapy is not possible?
16–20 Gy in 8–10 fractions
149
What is the purpose of a parametrial boost in brachytherapy?
To address distal parametrial disease at the time of brachytherapy
150
What is the typical dose delivered in a parametrial boost?
6–10 Gy in 3–5 fractions
151
What chemotherapy is given with EBRT for cervical cancer?
Cisplatin 40 mg/m2 (maximum 70 mg) weekly for 5 weeks
152
Cervical Cancer Management Algorithm
153
cervical cancer recurrence management
154
155
What does Stage I of FIGO cervical cancer staging indicate?
Confined to the cervix (extension to the corpus disregarded)
## Footnote
This includes various sub-stages based on the extent of invasion.
156
What is defined as Stage IA in cervical cancer?
Invasive carcinoma diagnosed only by microscopy
## Footnote
It is characterized by specific depth and extension measurements.
157
What are the criteria for Stage IA1?
Stromal invasion of ≤3.0 mm in depth and extension of ≤7.0 mm
158
What defines Stage IA2 in cervical cancer?
Stromal invasion of >3.0 mm and not >5.0 mm with an extension of not >7.0 mm
159
What characterizes Stage IB of cervical cancer?
Clinically visible lesions limited to the cervix uteri or pre-clinical cancers greater than stage IA
160
What is the maximum dimension for a clinically visible lesion to be classified as Stage IB1?
≤4.0 cm in greatest dimension
161
What defines Stage IB2 in cervical cancer?
Clinically visible lesion >4.0 cm in greatest dimension
162
What does Stage II indicate in cervical cancer staging?
Cervical carcinoma invades beyond the uterus, but not to the pelvic wall or to the lower third of the vagina
163
What is the classification for Stage IIA without parametrial invasion?
IIA
164
What criteria define Stage IIA1?
Clinically visible lesion ≤4.0 cm in greatest dimension
165
What distinguishes Stage IIA2?
Clinically visible lesion >4 cm in greatest dimension
166
What characterizes Stage IIB in cervical cancer?
Parametrial invasion
167
What defines Stage III in cervical cancer staging?
Tumor involves lower third of the vagina, with no extension to the pelvic wall
168
What does Stage IIIA indicate?
Tumor involves lower third of the vagina, with no extension to the pelvic wall
169
What are the implications of Stage IIIB?
Extension to the pelvic wall and/or hydronephrosis or non-functioning kidney
170
What does Stage IV of cervical cancer indicate?
Extended beyond the true pelvis or has involved (biopsy proven) the mucosa of the bladder or rectum
171
What is defined by Stage IVA?
Spread of the growth to adjacent organs
172
What distinguishes Stage IVB?
Spread to distant organs
173
black Arrow ?
B/L parametrium involvement
