Cervix

Question 1

What is the cervix?

Answer 1

The cervix is the lower 1/3 of the uterus where it connects with the superior portion of the vagina.

Question 2

What is the internal os?

Answer 2

The internal os is part of the cervix that is closest to the body of the uterus.

Question 3

What is the external os?

Answer 3

The external os is the opening of the cervix on the vaginal end.

Question 4

What type of epithelium lines the external os?

Answer 4

The external os is lined with squamous cell epithelium.

Question 5

What is the exocervix?

Answer 5

The exocervix is the part of the cervix closest to the vagina.

Question 6

What is the rank of cervix cancer among common cancers in women?

Answer 6

It is the 3rd most common cancer in women.

Question 7

What age group is cervix cancer most common in?

Answer 7

It is most common in women under 50 years old.

Question 8

In which socioeconomic groups is cervix cancer commonly found?

Answer 8

It is common in low socioeconomic groups.

Question 9

What is the most important risk factor for cervix cancer?

Answer 9

Human Papilloma Virus (HPV) is the most important risk factor.

Question 10

What are the estimated new cases of cervix cancer in 2024?

Answer 10

13,820 estimated new cases.

Question 11

What are the estimated deaths from cervix cancer in 2024?

Answer 11

4,360 estimated deaths.

Question 12

What is the incidence rate of cervix cancer from 2016-2020?

Answer 12

The incidence rate is 7.7 per 100,000.

Question 13

What is the mortality rate of cervix cancer from 2017-2021?

Answer 13

The mortality rate is 2.2 per 100,000.

Question 14

What is the most common presenting symptom of cervical cancer?

Answer 14

Abnormal vaginal bleeding

Question 15

What bowel symptoms are associated with advanced cervical cancer?

Answer 15

Bowel symptoms are usually related to advanced disease with tumor invasion into the rectum.

Question 16

At what age should women begin cervical cancer testing?

Answer 16

All women should begin cervical cancer testing (screening) at age 21.

Question 17

How often should women aged 21 to 29 have a Pap test?

Answer 17

Women aged 21 to 29 should have a Pap test every 3 years.

Question 18

Should HPV testing be used for screening in women aged 21 to 29?

Answer 18

HPV testing should not be used for screening in this age group.

Question 19

How often should women aged 30 and older have Pap and HPV co-testing?

Answer 19

Women aged 30 and older should have Pap and HPV co-testing every 5 years.

Question 20

What is colposcopy?

Answer 20

Colposcopy is performed on women who have abnormal Pap smear results or who are at a high risk for the development of cervical cancer.

Question 21

What is cervical cancer?

Answer 21

Cervical cancer starts in the cells lining the cervix.

Question 22

What are the two parts of the cervix?

Answer 22

The cervix is made of two parts: the endocervix and the exocervix.

Question 23

What type of cells cover the endocervix?

Answer 23

The endocervix is covered with glandular cells.

Question 24

What type of cells cover the exocervix?

Answer 24

The exocervix is covered in squamous cells.

Question 25

What is the transformation zone?

Answer 25

The place where the endocervix and exocervix meet.

Question 26

What is the most common histology of cervical cancer?

Answer 26

Squamous cell carcinoma.

Question 27

What are the other types of cervical cancer histology?

Answer 27

Adenocarcinoma and adenosquamous carcinoma.

Question 28

What is the most commonly used staging system for cervix staging?

Answer 28

FIGO

Question 29

What is the most significant prognostic factor in cervix staging?

Answer 29

Staging

Question 30

What does cervix staging 1b indicate?

Answer 30

Cancer has grown into the top part of the vagina.

Question 31

What size is classified under cervix staging 2a?

Answer 31

4mm or smaller.

Question 32

What does cervix staging 2b indicate?

Answer 32

Cancer has grown into the top part of the vagina.

Question 33

What does cervix staging 1b2 indicate?

Answer 33

Larger than 4mm.

Question 34

What does cervix staging 3a indicate?

Answer 34

Cancer has grown into the lower third of the vagina.

Question 35

What type of tumors are cervical cancers?

Answer 35

Cervical cancers are slow-growing tumors that directly invade adjacent tissues.

Question 36

What is the process of metastasis in cervical cancer?

Answer 36

Metastasis includes direct extension into the uterus, the vagina, the parametrium, the abdomen, the pelvis, the rectum, and the bladder.

Question 37

How does lymphatic involvement occur in cervical cancer?

Answer 37

Lymphatic involvement is usually orderly, involving parametrial nodes, common iliac, periaortic, and even supraclavicular nodes.

Question 38

What are the hematogenous routes for cervical cancer spread?

Answer 38

Cervical cancer may also spread via hematogenous routes.

Question 39

What are the most common distant sites involved in cervical cancer metastasis?

Answer 39

The most common distant sites involved are the lungs, the liver, and bone.

Question 40

What nodes are involved in the lymphatic spread of cervical cancer?

Answer 40

The involved nodes include periaortic nodes, common iliac nodes, external iliac nodes, internal iliac nodes, and obturator nodes.

Question 41

What is a common treatment for early staged cervical cancer?

Answer 41

Surgery, specifically Total Abdominal Hysterectomy (TAH) with or without a small amount of vaginal tissues, referred to as the vaginal cuff.

Question 42

When should radiation therapy be considered for cervical cancer?

Answer 42

If the tumor is still confined to the cervix but surgical removal is not possible.

Question 43

How are patients with advanced stage cervical cancer treated?

Answer 43

They are treated with radiation with or without chemotherapy.

Question 44

What does EBRT target in cervical cancer treatment?

Answer 44

EBRT targets the pelvic lymph nodes, parametria, and primary tumor, to a dose adequate to control microscopic disease.

Question 45

What is the purpose of chemotherapy in cervical cancer treatment?

Answer 45

Chemotherapy serves predominantly as a radiosensitizer.

Question 46

What is the benefit of a therapy boost in cervical cancer treatment?

Answer 46

It boosts the gross tumor and improves disease control.

Question 47

What type of beams are necessary for external beam treatment of cervical cancer?

Answer 47

High-energy photon beams are necessary due to the thickness of the pelvic area.

Question 48

What are the techniques used for radiation treatment in cervical cancer?

Answer 48

Four field box, IMRT, and VMAT are the techniques used.

Question 49

What is the typical dose for whole pelvis with EBRT?

Answer 49

The typical dose is 40-50 Gy plus intracavitary brachytherapy.

Question 50

What are the tumor total doses for cervical cancer?

Answer 50

Tumor total doses are increased from 70 Gy for low-volume disease to 85 Gy for advanced or bulky disease.

Question 51

What are the organs at risk (OARs) in cervical cancer radiation treatment?

Answer 51

The organs at risk include the rectum and bladder.

Question 52

What helps avoid organs at risk (OARs) in radiation treatment?

Answer 52

Numerous dose, field, and sequence arrangements help avoid OARs.

Question 53

What is the goal of intracavitary radiation for cervical cancer?

Answer 53

To deliver 50 to 60 Gray to microscopic disease, 60 to 70 Gray to small macroscopic disease, and 70 to 90 Gray to large macroscopic disease while limiting the volume and dose to the bladder, colorectal tissues, and small intestine.

Question 54

Where is Point A located?

Answer 54

Point A is located 2 cm cephalad and 2 cm lateral from the external cervical os.

Question 55

Where is Point B located?

Answer 55

Point B is located 5 cm lateral to the center of the pelvis at the same level as Point A.

Question 56

What are the components involved in the intracavitary radiation procedure?

Answer 56

Uterine cavity, external os of cervix, tandem with sources, and vagina.

Question 57

What is the purpose of external beam treatment in brachytherapy for cervical cancer?

Answer 57

Shrinkage of bulky tumor during the external beam portion of the treatment results in better geometry for the brachytherapy implant.

Question 58

What are the components used in brachytherapy for cervical cancer?

Answer 58

A standard intrauterine tandem and vaginal colpostats are placed laterally to the tandem into the vaginal fornixes.

Question 59

What is the radioactive source used in LDR brachytherapy?

Answer 59

LDR- Cesium-137 delivered over 1-2 fractions, with treatment times of typically 1-3 days, requiring prolonged patient immobilization.

Question 60

What is the radioactive source used in HDR brachytherapy?

Answer 60

HDR- Iridium-192 delivered at a point A dose rate of >12 Gy/hour.

Question 61

What are the advantages of HDR brachytherapy?

Answer 61

Advantages of HDR include precise positioning of the source, shorter treatment times (minutes versus days), and protection of health care personnel from radiation exposure.

Question 62

Where are the ovoids placed for cervical cancer treatment?

Answer 62

The ovoids are placed in the lateral fornix on both sides of the cervix, as close to the pelvic sidewall as possible.

Question 63

What shape does the dose distribution result in for cervical cancer treatment?

Answer 63

This results in a pear-shaped dose distribution.

Question 64

What are the acute side effects of radiation treatment for cervical cancer?

Answer 64

Fatigue, Diarrhea (if radiation is given to the pelvis or abdomen), Cystitis, Nausea, Anorexia, Skin changes

Question 65

What are the chronic side effects of radiation treatment for cervical cancer?

Answer 65

Chronic cystitis, Proctosigmoiditis, Small bowel enteritis, Obstruction