Cervical Cancer

Question 1

HPV in Cervical Cancer

Answer 1

16/18

 E7 inactivates Rb, E6 inactivates TP53

Question 2

Treatment of CIN 2/3

Answer 2

If CIN3 on biopsy then CKC (or LEEP) + ECC
 To rule out underlying invasion
 To treat CIN3
 “Hysterectomy is unacceptable as primary
therapy for CIN 2, CIN 3, or CIN 2,3” (ACOG PB 2013)
 May be treated with a hysterectomy after ruling
out invasive cancer
 If no hysterectomy then CKC with negative
margins

Question 3

Follow up Cone for CIN3

Answer 3

If CIN3 on biopsy then CKC (or LEEP) + ECC
 To rule out underlying invasion
 To treat CIN3
 “Hysterectomy is unacceptable as primary
therapy for CIN 2, CIN 3, or CIN 2,3” (ACOG PB 2013)
 May be treated with a hysterectomy after ruling
out invasive cancer
 If no hysterectomy then CKC with negative
margins

Question 4

Follow up Cone for Adenocarcinoma in situ

Answer 4

Treatment is traditionally hysterectomy
 Conization alone is appropriate in selected
situations (i.e. desires fertility, negative margins)
 ~ 10-25% persistent disease with – margins;
~ 2.5% AIS recurrence with –margin, 20% with ++;
~ 5% invasive cancer with ++margins, <0.1% if -

AIS:
 Negative margins:
 hysterectomy preferred
 “long term follow up”
(consider co-testing and ECC at 12+24 mos)
 Positive margins:
 Re-excision recommended
 re-evaluation at 6 months with co-testing and
colposcopy with ECC is acceptable

Question 5

Cervical Cancer Staging Studies

Answer 5

CXR
 IVP
 Barium enema
 Cystoscopy
 Proctoscopy
 Conization

Question 6

Stage 1 and 2 of Cervical Cancer

Answer 6

Stage IA – Microscopic (3-5 depth, 7 mm width)
 Stage IB – Visible Lesion (≤ or > 4 cm)
 Stage IIA and IIIA – Refers to the vagina
 Stage IIA: upper 2/3
 Stage IIIA: lower 1/3
 Stage IIB: Parametrial involvement

Question 7

Stage 3 or 4 of Cervical Cancer

Answer 7

Stage III – Regional extension
 Pelvic sidewall disease (Exam)
 Hydronephrosis (IVP, CT)
 Stage IV – Distant disease
 Bowel or bladder mucosal (Cysto–Procto)
 Pulmonary metastasis (CXR)
 Supraclavicular metastasis (Exam)

Question 8

When is Cone Adequate

Answer 8

microinvasive- no lymphvascular invasion
ECC negative
Margins Clear

If margins or ECC is positive can consider repeat cone

Question 9

When is Radical Trach and option

Answer 9

<2 cm tumor
No lymphvascular invasion
Negative ECC

Question 10

When is Radical Hyst and option?

Answer 10

Stage 1A-1B

Question 11

What chemo is generally used for cervical cancer?

Answer 11

Cisplatin

Question 12

When does Rad Hyst need further treatment?

Answer 12

Lymphovascular space, large tumor, deep invasion - consider radiation/chemo

Positive margins, Postitive lymph nodes, + parametrium - Rads and chemo

Question 13

What to do with Stage 2 or up in pregnancy

Answer 13

Chemo/Rads

Question 14

What to do with microinvasive disease in pregnancy

Answer 14

vaginal delivery

Reevaluate 6 wk pp

Question 15

Stage 1 A but not microinvasive in pregnancy

Answer 15

Cesarean Section at lung maturity
Cesarean radical hyst and lymphadenectomy
Radiation after recovery

Question 16

Stage 1B2 in pregnancy

Answer 16

chemo during pregnancy with definitive management at or after delivery