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Flashcards in Cervix CA Deck (17):
1

What are the usual histologies for Cervix CA?

1) Squamous Cell Carcinoma (80%) - High risk
- Large cell Keratinising
- Large cell non-Keratinising
- Small Cell
2) AdenoCarcinoma (15%) - High risk
3) Neuroendocrine

2

What are the risk factors for Cervix CA?

1) Smoking
2) immunocompromised
3) Early age of 1st sexual activity
4) multiple parity
5) Earlier age at first birth
6) Multiple sexual partners
7) Hx of STIs
8) Hx of vulvar/vaginal intraepithelial neoplasms or cancer
9) High risk sexual partner
10) non-white
11) Lower socio-economic status
12) Genetics
13) Sex with uncircumcised male
14) Oral contraceptives usage

3

Tell me more about HPV infection

As high as 45% in women 25-29yo in US
Majority clear the virus w/o specific intervention (90%)
In a minority, the virus persistS

With persistent infection, HPV Genes E6 and E7 are incorporated into cervix cells
- Viral proteins capable of binding to and inactivating tumor suppression proteins are produced. (
- HPV subtype 15 high risk
- HPV 16 and HPV 18 most prevalent, and are responsible for >70% of cervical cancer worldwide

4

What are the 2 HPV Vaccines that you know of:

Gardasil (6,11,16,18)

Cervarix (16,18)

5

What are the low risk HPV subtypes

6,11
- low grade squamous intra-epithelial lesion (SIL)/condylomata

6

What are the high risk subtypes for HPV?

16,18, 31, 33, 52

7

Tell me in brief the FIGO staging for Cervix CA

I - Limited to uterus

I - Extends beyond the cervix, but not to the pelvic side wall or to lower 1/3 of vagina

III - Extends to pelvic side wall or to lower 1/3 of the vagina, or causes hydronephrosis

IV - extends beyond true pelvis; and/or invades mucosa of bladder/rectum; or distant mets

8

Tell me about FIGO Stage I of the cervix

IA:
- invasive carcinoma Dx only by microscopy
IA1:
Lesions 3 cm or less in depth of stromal invasion, 3m and 4cm

9

Tell me about FIGO stage II of cervical CA

II: tumor extends beyond cervix, but not to pelvic side wall and not to lower 1/3 of vagina

IIA1: No parametric like invasion, clinically visible lesion 4cm

IIB: extends to parametria

10

Tell me about FIGO stage 4 for cervix

IVA: Extends beyond true pelvis, and/or invades mucosa of bladder/rectum

IVB: Distant mets

11

What is the GOG score?

= relative risk for the depth X tumor size X capillary space involvement

GOG score 120 = Standard field RT+ brachytherapy OR Small field RT+Brachytherapy

12

What are the indications for adjuvant RT?

>pT2a

13

What is the Sedilis Criteria?

1) >1/3 stromal invasion
2) LVSI
3) Tumor size

14

What are the 5 trials that show better survival rates with concurrent ChemoRT for locally advanced Cervical CA?

1) GOG 123
2) GOG 120
3) GOG 85
4) SWOG 8797
5) RTOG 9001

15

What is GOG 123?

Stehman et al

Aim: Confirm tt concurrent ChemoRT with CDDP a/w improved long-term PFS and OS compared with RT alone in stage IB bulky cervix CA

N=370
Bulky Stage IB cervix Ca, randomized to 2 arms
2 arms:
1) Chemo/RT
2) RT alone

RESULTS:
4y OS: 85% vs 75% (RT alone)
4y PFS 80% vs 60% (RT alone)

16

What is GOG 120

Peter Rose JCO 2007 (updated analysis at 8y)

N=500
Locally advanced with pathologically Negative para-aortic LN
S/p external-beam RT according to a strict protocol

3 arms:
1) CDDP (40)X 6 weeks
2) CDDP (50) D1, D29 --> FU 4g/m2 over 96 hours D1, 29 + 2g/m2 Hydroxyurea twice weekly X 6 weeks
3) 3g/m2 Oral hydroxyurea twice weekly for 6 weeks

RESULTS:
CDDP-based chemo during pelvic RT improves long-term PFS and OS
No observed increase in late toxicity with CDDP-based ChemoRT.

17

Tell me about the SWOG 8797

Peters et al
N=250
CS IA2, IB, IIA s/p radical hysterectomy and pelvic lymphadenectomy ,+positive LN and/or +margins and/or microscopic involvement of the parametrium

2 arms:
1) RT
2) RT + Chemo

RESULTS:
4y PFS 80% vs 60%(RT)
4y OS 80% vs 70%