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Gyne Oncology > Cervix > Flashcards

Flashcards in Cervix Deck (12)
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1
Q

Describe primary and secondary prevention of cervix cancer.

A

Primary prevention - HPV vaccination prior to sexual debut

Secondary prevention - screening for & treatment of precancerous lesions

2
Q

In low-resources countries, visual inspection of the cervix (with application of acetic acid) may be used instead of cytology for cervical cancer screening. How do the two tests compare?

A

Similar sensitivity, visual inspection less specific (therefore risk of over-treatment), visual inspection more cost-effective, visual inspection easier to learn

3
Q

Which of the following is the most effective test for reducing diagnosis of & death from cervix cancer?

  • Visual inspection
  • Cytology
  • HPV testing
A

HPV testing

4
Q

A woman is referred to you with an ASC-H Pap. Colposcopy does not reveal any lesions. What is your next diagnostic step?
How would your next step be different if she were referred with an HSIL Pap?

A

ASC-H: Follow up colposcopy, cytology, and HPV testing in 6 months (diagnostic excisional procedure not necessary at this time)
HSIL: Immediate diagnostic excisional procedure

5
Q

How would you manage a 32-year-old woman whose Pap was normal but who tested positive for HR-HPV?

A

Repeat Pap & HPV testing in 12 months - return to routine screening if both negative, refer to colposcopy if either positive

6
Q

Under what circumstances can you consider ablative treatment of precancerous lesions?

A

Fully visible transformation zone
No suspicion invasive or glandular disease
No disparity between cytology and histology
No previous treatment for dysplasia
Lesion is CIN 2 or less (cryo only)

7
Q

What cervical cancer screening is recommended for women who are HIV positive?

A

Annual Pap (colposcopy for usual indications only)

8
Q

What two investigations are permitted when staging cervical cancer?

A

CXR

IVP

9
Q

What are the three components of the GOG score for cervical cancer?

A

Tumour size
Depth of invasion
Presence of LVSI

10
Q

You are a gynecologic oncologist and have done a cone biopsy for HSIL. Final pathology diagnoses an invasive cervical cancer. The endocervical margin is positive. What is the most appropriate next step?

A

Repeat cone biopsy - more deeply invasive disease may be identified which will impact your treatment (simple hysterectomy vs radical hysterectomy vs non-surgical management)

11
Q

Describe some of the reasons why a woman might choose surgery rather than primary radiation therapy for a stage IB1 or IIA1 cervical cancer.

A

Cure rates are equal, surgery is typically less morbid

  • Injury to bladder/bowels/vagina heals better as blood supply is not compromised
  • Sexual dysfunction may be more easily treatable since the unirradiated vagina is more elastic and more responsive to local estrogen
  • Ovarian function is preserved, where applicable
  • Fertility preservation may be an option
12
Q

What is the rationale behind the addition of chemotherapy to primary RT for advanced (inoperable) cervical cancer?

A

Chemo makes the tumour more radiation-sensitive, allows sterilization with a lower total dose of RT (therefore less RT-associated morbidity)