Cervical Cancer OXCOG podcast

Question 1

UK Stats for cervical cancer
Cases per year in UK
Case per 100

Answer 1

3200 in UK
3rd most common gynae cancer in developed (Endometrial, Ovarian)
lifetime risk of developing cervical 7 in 1000 women UK

In developing countries 2nd most common cancer, 3rd most common cancer death (most common gnar cancer worldwide)

Question 2

HPV is detected in what % cervical cancers?

Answer 2

99.7%

Question 3

What are the most common types of cervical cancer?

Answer 3

Squamous Cell carcinoma 70%
Adenocarcinoma 25%

Question 4

RF cervical cancer

Answer 4

HPV related
- Early onset sexual activity
- Multiple sexual partners
- High risk sexual partner
- Hx STIs
- immunosupression

Non HPV related
- Low socioeconomic status
- COCP > 5years, background after 10 years
- Cigarette smoking - squamous cell not adenocarcinoma
- Genetics

Question 5

How many HPV are oncogenic

Answer 5

15 of the 40 HPV
HPV 16&18 in 70% of cervical cancers

Question 6

How many sexual active patient have HPV at some point

Answer 6

75-85%, most people clear the virus

Question 7

Squamous cell carcinoma - HPV subtypes

Answer 7

16 60%
18 13%
58/33 5%

Question 8

Adenocarcioma cell carcinoma - HPV

Answer 8

16 36%
18 37%
45 5%

Question 9

Presenting Sx cervical cancers

Answer 9

Asymptomatic
IMB/PCB/PMB
Dyspareuniria
Abnormal vaginal discharge
Abnormal speculum
Haematuia
Urinay incontince
Loin pain (hydronephrosis)
Weight loss
Change bladder/bowel

Question 10

Peak age incidence of cervical carcinoma

Answer 10

25-29yrs
rare <25yrs

Question 11

Cervical cancer %
localised/regional/mets at diagnosis

Answer 11

44% localised
34% regional
15% distant mets

Question 12

How to Dx cervical cancer

Answer 12

Colposcopy and biopsy (punch Bx, multiple or LLETZ)

Question 13

Where does cervical cancer spread locally

Answer 13

Vagina
Parametrium
Uterosacral ligaments

Bladder/rectum/para aorta lymph nodes

Question 14

Where does cervical cancer spread distantly

Answer 14

Bone, liver, lungs

Question 15

FIGO Stage 1a
1a1
1a2

Answer 15

1a Microscopic <5mm
1a1 Stromal <3mm
1a2 Stromal 3-5mm

Question 16

Figo Stage 1b
1b1
1b2
1b3

Answer 16

Figo Stage 1b Deepest invasion >5mm
1b1 Dimension <2cm
1b2 Dimension 2-4cm
1b3 Dimension >4cm

Question 17

FIGO Stage 2

Answer 17

Metastasised to uterus not not lower 1/3 vagina or side wall

Question 18

Figo Stage 2a
2a1
2a2

Answer 18

Figo Stage 2a: upper 2/3 vagina, no parametrium
2a1 <4cm dimension
2a2 >4cm dimension

Question 19

FIGO stage 2b

Answer 19

Parametrial invasion no side wall

Question 20

FIGO stage 3

Answer 20

Further local spread
Lower 1/3
Pelvic side wall
Hydropnephrosis
Involves pelvic or para-aortic lymph noces

Question 21

FIGO
3a
3b

Answer 21

3a Lower 1/3 vagina
3b Pelvic side wall, hydronephrosis, non functioning kidney

Question 22

FIGO stage 3c
3c1
3c2

Answer 22

FIGO stage 3c Local Lymph nocdes
3c1 Pelvic
3c2 para-aortic

Question 23

FIGO stage 4
4a
4b

Answer 23

Beyond true pelvis, involved Bx proved mucosa bladder/rectum
4a Adjacent pelvic organs
4b distant organs

Question 24

5 year surgical stage 1 cervical cancer

Answer 24

95%

Question 25

5 year surgical stage 2 cervical cancer

Answer 25

70%

Question 26

5 year surgical stage 3 cervical cancer

Answer 26

40%

Question 27

5 year surgical stage 5 cervical cancer

Answer 27

15%

Question 28

What cross sectional imaging can be used pre-op for cancers above 1a

Answer 28

MRI > CT - diffusion weighted increases sensitivity More accurate for staging 7-10 days after biopsy (prevent artefact) High negative predictive value bladder/bowel involvement Chest imaging - plain CXR If nodal disease suspected → FDG PET CT (If >1b2) Clinical examination also essential

Question 29

Gold standing for assessing lymph node mets

Answer 29

Sentinal lymph node biopsy - surgically

Question 30

Which cancers used Sentinal lymph node biopsy for staging?

Answer 30

Breast, vulval and cervical Helps assess for chemo-radiotherapy NPP 95%

Question 31

Surgical management for Stage 1a1 cervical cancer

Answer 31

Cold knife/Loop Coneisation with clear margins for cancer and dysplasia Non-fragmented speculum When completed family/fertility not desired → simple hysterectomy

Question 32

Complications from conisation (cone Bx, LLETZ)

Answer 32

Cervical imcompentence Stenosis Pre term delivery

Question 33

Surgical management Stage 1a2-1b2

Answer 33

Radical hysterectomy + BSO + pelvic lymphdenectomy Fertility preservation - conisation/trachelectomy with clear margins

Question 34

If those with adneocarcinoma what else should they be counselled on?

Answer 34

BSO - risk of recurrence in adenxa

Question 35

Surgical options for fertility preservation for cervical cancer up to stage 1b1

Answer 35

Radical trachelectomy + cerclage + BL lymphdectomy +/- genital node Bx consider up to 1b2

Question 36

When is adjacent chemo radiotherapy offered

Answer 36

Higher risk factors Unclear margins +ve pelvic lymph nodes Parametrial spread

Question 37

Treatment for local spread 1b3 onwards

Answer 37

Chemoradiotherapy External beam radiation, bracytherapy Cisplatin chemotherapy

Question 38

When is pelvic excenteration offered

Answer 38

Some cases 4a disease

Question 39

Neoadjuvant chemotherapy before surgery or radiation