Treatment of cervical cancer  Flashcards Preview

Oncology > Treatment of cervical cancer  > Flashcards

Flashcards in Treatment of cervical cancer  Deck (36):
1

How is biopsy taken in precancerous conditions

Cold knife cone biopsy from cervical os

2

Excisional biopsy is used when in cervical tumors

Locally advanced diseases. If positive tumor margins consider hysterectomy

3

Radiotherapy in cervical cancer

Significant role, but not used in early CIN
Most effective: combined treatment with surgery + radiotherapy +/- chemotherapy

4

When is curative radiotherapy

Neoadjuvant setting, adjuvant setting, or with definite intent

5

Palliative radiotherapy is given in cervical cancer

To reduce pain and bleeding in advanced stages, or in order to improve quality of life

6

Preoperative radiotherapy is done for

I/A-II/A early case with neoadjuvant radiotherapy to downsize the primary tumor and devitalize tumor cells

7

Brachytherapy for cervical cancer

2x8 Gy or 3x6 Gy given with an applicator inserted into the cervix and the vestibule of the vagina

8

If no residual tumors or LN-status after preoperative radiotherapy means

No postoperative radiotherapy after surgery

9

When to give radiotherapy as montherapy

If the pt is...
1.)Inoperable for medical reasons
2.) The tumor is in a very early in situ stage (stage 0)
3.) Microscopic invasive (St. I/A) tumors

10

Gray dosage for intracavitary HDR-BT

6-7 grays
Complemented with weekly BT-sessions with a dosage of 5-6x7 Gy

11

St.I/B2-II/B-III/A-IV/A

Radiotherapy (Teletherapy 45-50.4 Gy) with Cisplatin chemoradiotherapy

12

In St. I/B2­II/B­III/A­IV/A is complemented by

HDR-AL brachytherapy (3-4x 7 Gy dosage)

13

Post op radiotherapy

Intended to eradicate microscopic residual tumors, to decrease local/regional reoccurrence

14

Post op radiotherapy low risk groups treatment

No radiotherapy

15

Medium risk post op radiotherapy treatment

Intracavitary and external beam radiotherapy without chemotherapy.
Intravaginal HDR-AL treatment, external beam

16

What is a medium risk post op patient (cervical cancer)

-R0 resection, pN0, no paramterial spread
-poorly differentiated tumor (grade III) and/or
-LVSI-positive and/or
-Perineural spread is detected and/or
-Stromboli’s invasion is >10 mm and/or
-Surgical margins <3 mm

17

High risk patients post op (cervical cancer)

Requires postop simultaneous chemoradiotherapy (Cispaltin)- including HDR-AL treatment. Applied to vaginal stump + external beam RT.
Radiotherapy for para-aortic if there is involvement.

18

Which are the high risk cervical cancer patients

-R1-R2 resection (micro/macroscopic residual tumor) and/or
-LN (pN1) and/or
-Parametrial spread detected by examination

19

Palliative radiotherapy in cervical cancer

Distant metastasis are detected (St. IV/B), radiotherapy is given with palliative intent.

20

Purpose for palliative radiotherapy in cervical cancer

To alleviate complaints (pain, bleeding) and symptoms (ureter, obstruction, hydronephrosis, lower extremity lymphedema)

21

Acute bleeding caused by cervical carcinoma handled with

Intracavitary high dose brachytherapy
Along with possible vaginal tamponating, antihemorrhagic drugs, and transfusion

22

Metastasis of cervical cancer

Paraaortic LN, supraclavicular, inguinal, bone metastasis

23

Indication for surgical treatment in cervical cancer

Microinvasive or early invasive

24

St 1/A1 indication for surgery?

Every type of procedure is acceptable- from conization to hysterectomy

25

St. I/A2 surgical indication

LN metastasis and pelvic lymphadenectomy is recommended

26

St. I/B treatment

Macroscopic tumor confined to the cervix.
>4 cm tumor: radical surgery is recommended
<4 cm: definite chemotherapy

27

St. I/B1 cervical cancer treatment

Wertheim hysterectomy (uterus, ovaries, Fallopian tubes, parametrium, paravaginal tissues, upper half of the vagina, and pelvic lymph nodes). It is a nerve sparing procedure.

28

Which lymph nodes might be affected in cervical cancer

Iliac nodes and para-aortic

29

Fertility conserving surgery where the cervical and internal cervical os with parametria +upper 3rd of the vagina

Radical trachelectomy

30

What happens if LN metastasis has happened during radical trachelectomy?

Wertheim hysterectomy is required

31

Surgical treatment of ST. II/B cervical tumors?

Chemoradiotherapy

32

Pharmacological treatment for cervical cancers? When to use?

Cisplatin-paclitaxel-bevacizumab.
Used in metastatic or recurrent cervical cancer.

33

Follow of cervical cancer patients

1st and 2nd year: every 3 months
2+ years: every 6 months
5+ years: annually

34

Follow up examination of treated cervical cancer patients? Imaging?

Examination: gynecological bimanual and rectovaginal examination, cervicoscopy, colposcopy, and cytological sampling  ­ Imaging methods: MR is preferred → 1 st  scan taken 3 months after the termination of treatment → referred to as baseline imaging 
○ Pelvic MR is recommended semi­annually after this 
­ In case of suspected distant metastases: PET­CT may be useful, in addition to CT and MR. 

35

Stage 2a cervical cancer treatment

Radical hysterectomy (the parametrium is also taken out

36

In situ cervical cancer treatment

Conization