Flashcards in Treatment of cervical cancer Deck (36):
How is biopsy taken in precancerous conditions
Cold knife cone biopsy from cervical os
Excisional biopsy is used when in cervical tumors
Locally advanced diseases. If positive tumor margins consider hysterectomy
Radiotherapy in cervical cancer
Significant role, but not used in early CIN
Most effective: combined treatment with surgery + radiotherapy +/- chemotherapy
When is curative radiotherapy
Neoadjuvant setting, adjuvant setting, or with definite intent
Palliative radiotherapy is given in cervical cancer
To reduce pain and bleeding in advanced stages, or in order to improve quality of life
Preoperative radiotherapy is done for
I/A-II/A early case with neoadjuvant radiotherapy to downsize the primary tumor and devitalize tumor cells
Brachytherapy for cervical cancer
2x8 Gy or 3x6 Gy given with an applicator inserted into the cervix and the vestibule of the vagina
If no residual tumors or LN-status after preoperative radiotherapy means
No postoperative radiotherapy after surgery
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
Gray dosage for intracavitary HDR-BT
Complemented with weekly BT-sessions with a dosage of 5-6x7 Gy
Radiotherapy (Teletherapy 45-50.4 Gy) with Cisplatin chemoradiotherapy
In St. I/B2II/BIII/AIV/A is complemented by
HDR-AL brachytherapy (3-4x 7 Gy dosage)
Post op radiotherapy
Intended to eradicate microscopic residual tumors, to decrease local/regional reoccurrence
Post op radiotherapy low risk groups treatment
Medium risk post op radiotherapy treatment
Intracavitary and external beam radiotherapy without chemotherapy.
Intravaginal HDR-AL treatment, external beam
What is a medium risk post op patient (cervical cancer)
-R0 resection, pN0, no paramterial spread
-poorly differentiated tumor (grade III) and/or
-Perineural spread is detected and/or
-Stromboli’s invasion is >10 mm and/or
-Surgical margins <3 mm
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.
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
Palliative radiotherapy in cervical cancer
Distant metastasis are detected (St. IV/B), radiotherapy is given with palliative intent.
Purpose for palliative radiotherapy in cervical cancer
To alleviate complaints (pain, bleeding) and symptoms (ureter, obstruction, hydronephrosis, lower extremity lymphedema)
Acute bleeding caused by cervical carcinoma handled with
Intracavitary high dose brachytherapy
Along with possible vaginal tamponating, antihemorrhagic drugs, and transfusion
Metastasis of cervical cancer
Paraaortic LN, supraclavicular, inguinal, bone metastasis
Indication for surgical treatment in cervical cancer
Microinvasive or early invasive
St 1/A1 indication for surgery?
Every type of procedure is acceptable- from conization to hysterectomy
St. I/A2 surgical indication
LN metastasis and pelvic lymphadenectomy is recommended
St. I/B treatment
Macroscopic tumor confined to the cervix.
>4 cm tumor: radical surgery is recommended
<4 cm: definite chemotherapy
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.
Which lymph nodes might be affected in cervical cancer
Iliac nodes and para-aortic
Fertility conserving surgery where the cervical and internal cervical os with parametria +upper 3rd of the vagina
What happens if LN metastasis has happened during radical trachelectomy?
Wertheim hysterectomy is required
Surgical treatment of ST. II/B cervical tumors?
Pharmacological treatment for cervical cancers? When to use?
Used in metastatic or recurrent cervical cancer.
Follow of cervical cancer patients
1st and 2nd year: every 3 months
2+ years: every 6 months
5+ years: annually
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.
Stage 2a cervical cancer treatment
Radical hysterectomy (the parametrium is also taken out