Cervical Cancer Management and Epidemiology

Cervical cancer is the second most common female malignancy after breast cancer.

Incidence rates decreased by 49%.

Mortality rates were 71% lower than they were in 1971-1973.

<p>Cases should be managed in a recognised cancer centre.</p> Signup and view all the answers

<p>3207 new cases were diagnosed.</p> Signup and view all the answers

<p>The incidence rate was 8.4 per 100,000 women.</p> Signup and view all the answers

<p>Identify patients with risk factors for cervical cancer.</p> Signup and view all the answers

<p>A natural history study would provide insights.</p> Signup and view all the answers

<p>Older patients have a poorer prognosis.</p> Signup and view all the answers

<p>Yes, it is the treatment of choice.</p> Signup and view all the answers

<p>Stage IA disease can be treated by simple hysterectomy.</p> Signup and view all the answers

<p>No, bilateral oophorectomy is not necessary.</p> Signup and view all the answers

<p>Lymphoedema is a recognized complication.</p> Signup and view all the answers

<p>The overall 5-year survival rate is 68%.</p> Signup and view all the answers

<p>The incidence fell by 42%.</p> Signup and view all the answers

<p>It involves the removal of the bladder, not the rectum.</p> Signup and view all the answers

<p>Human papillomavirus (HPV) is predominantly associated.</p> Signup and view all the answers

<p>HPV testing helps triage women with low-grade and borderline smears.</p> Signup and view all the answers

<p>HPV 16 and 18 are the most oncogenic types.</p> Signup and view all the answers

<p>HPV typing improves detection of CIN2 and reduces false positives.</p> Signup and view all the answers

<p>Chemoradiotherapy has led to substantial improvements in survival rates.</p> Signup and view all the answers

<p>About 70% of cervical tumors are squamous lesions.</p> Signup and view all the answers

<p>It allowed for the primary prevention of most cervical cancers.</p> Signup and view all the answers

<p>HPV-16 and HPV-18 are the most common high-risk types.</p> Signup and view all the answers

<p>The goal is to treat cancer while preserving the patient's fertility.</p> Signup and view all the answers

<p>It is considered an important risk factor for cervical cancer.</p> Signup and view all the answers

<p>HPV is found in over 95% of cervical cancers.</p> Signup and view all the answers

<p>Regular 3-yearly smears help significantly reduce the risk of cervical cancer.</p> Signup and view all the answers

<p>Lymphomas are one of the rare tumor types.</p> Signup and view all the answers

<p>Age is an important prognostic factor, influencing treatment outcomes.</p> Signup and view all the answers

<p>A chest x-ray is included to assess the risk of pulmonary metastases.</p> Signup and view all the answers

<p>Clinical examination and imaging are standard methods for assessing tumor volume.</p> Signup and view all the answers

<p>Cigarette smoking is positively correlated with progression of preinvasive disease.</p> Signup and view all the answers

<p>Many cervical cancer patients may be asymptomatic, increasing the importance of regular screenings.</p> Signup and view all the answers

<p>MRI scans provide greater accuracy in assessing the disease extent pre-operatively.</p> Signup and view all the answers

<p>Radical surgery and chemoradiotherapy are the primary treatment options.</p> Signup and view all the answers

<p>It reveals high-grade cervical glandular intraepithelial neoplasia and adenocarcinoma.</p> Signup and view all the answers

<p>Stage IIB carcinoma of the cervix.</p> Signup and view all the answers

<p>The tumor demonstrates extension into the upper vagina.</p> Signup and view all the answers

<p>It indicates Stage IIIB carcinoma of the cervix.</p> Signup and view all the answers

<p>It suggests advanced disease, likely Stage IVB carcinoma of the cervix.</p> Signup and view all the answers

<p>Surgery or radical chemoradiotherapy may be administered with curative intent.</p> Signup and view all the answers

<p>They ensure that treatment decisions consider various expert opinions and patient wishes.</p> Signup and view all the answers

<p>No further treatment is necessary, but careful follow-up is essential.</p> Signup and view all the answers

<p>Further local excision should be performed or a simple hysterectomy may be considered.</p> Signup and view all the answers

<p>Radical radiotherapy is an alternative treatment option.</p> Signup and view all the answers

<p>A normal CXR indicates that there are no pulmonary metastases.</p> Signup and view all the answers

<p>It suggests advanced cervical cancer, possibly Stage IIIB or higher.</p> Signup and view all the answers

<p>The incidence of adenocarcinoma is approximately 20%.</p> Signup and view all the answers

<p>It indicates a likely Stage IVA carcinoma of the cervix.</p> Signup and view all the answers

<p>The two vaccines are Cervarix® targeting HPV-16 and HPV-18, and Gardasil® targeting HPV-6, HPV-11, HPV-16, and HPV-18.</p> Signup and view all the answers

<p>Vaccination is targeted at young girls because it is most effective when administered before they become sexually active.</p> Signup and view all the answers

<p>Three doses of the HPV vaccine are required, administered at 0, 2, and 6 months.</p> Signup and view all the answers

<p>The vaccines are expected to reduce the incidence of high-grade CIN, which may lead to a decrease in cervical carcinoma rates over time.</p> Signup and view all the answers

<p>Cervical screening will continue to play an important role, especially since HPV vaccination may not benefit women already exposed to the virus.</p> Signup and view all the answers

<p>Concerns include social taboos and the logistical challenges of vaccination, as well as the high rates of cervical cancer in these regions.</p> Signup and view all the answers

<p>Herd immunity refers to the indirect protection from HPV infection that occurs when a significant portion of the population is vaccinated.</p> Signup and view all the answers

<p>Gardasil® provides coverage for HPV types 6 and 11 in addition to 16 and 18, targeting both cervical cancer and genital warts.</p> Signup and view all the answers

<p>The HPV vaccines have an excellent safety record, primarily showing transient injection site reactions with no evidence of adverse effects on chronic disorders.</p> Signup and view all the answers

<p>Approximately 30% of cervical cancer cases are due to other HPV subtypes not targeted by the vaccines.</p> Signup and view all the answers

<p>The UK vaccination program has been in place since September 2008 and targets girls aged 12–13 years.</p> Signup and view all the answers

<p>Some opponents argue that HPV vaccination may encourage early sexual activity, with concerns raised by conservative and religious groups.</p> Signup and view all the answers

<p>One future strategy could include HPV testing, reserving cytology for those who test HPV-positive.</p> Signup and view all the answers

<p>Current data suggests that immune responses persist through 5 years after vaccination.</p> Signup and view all the answers

<p>Features of invasive disease such as atypical blood vessels may warrant a referral.</p> Signup and view all the answers

<p>A necrotic tumor may not exfoliate abnormal cells, leading to a false negative result.</p> Signup and view all the answers

<p>Accurate clinical staging is essential for determining the appropriate management of cervical cancer.</p> Signup and view all the answers

<p>Colposcopy, examination under anesthesia (EUA), and endocervical curettage are among the recommended examinations.</p> Signup and view all the answers

<p>Errors in clinical staging were reported at 24% for stage IB and up to 67% for stage IVA tumors.</p> Signup and view all the answers

<p>MRI has been shown to be superior to computed tomography and clinical examination for evaluating cervical tumors.</p> Signup and view all the answers

<p>The maximum depth of invasion for stage IA1 is ≤3 mm.</p> Signup and view all the answers

<p>Stage IB1 involves lesions ≤4 cm, while stage IB2 involves lesions &gt;4 cm in greatest dimension.</p> Signup and view all the answers

<p>Stage III indicates that the tumor extends to the pelvic wall and/or the lower third of the vagina.</p> Signup and view all the answers

<p>Surgical staging is usually performed as part of a clinical trial due to uncertainty in routine practices.</p> Signup and view all the answers

<p>It indicates stage III or stage IV cervical cancer, depending on other conditions.</p> Signup and view all the answers

<p>The International Federation of Gynecology and Obstetrics (FIGO) adapted the staging guidelines.</p> Signup and view all the answers

<p>Stage IV is defined by carcinoma that has extended beyond the true pelvis or involved other organs.</p> Signup and view all the answers

<p>Involvement of vascular or lymphatic spaces does not change the stage allotment.</p> Signup and view all the answers

<p>The depth of invasion should be reported in millimeters, regardless of classification.</p> Signup and view all the answers

<p>Radical hysterectomy and bilateral pelvic lymphadenectomy are generally preferred.</p> Signup and view all the answers

<p>Cisplatin is the chemotherapy agent typically used.</p> Signup and view all the answers

<p>A radical trachelectomy may be offered.</p> Signup and view all the answers

<p>Serious complications such as haemorrhage and damage to adjacent organs are significant risks.</p> Signup and view all the answers

<p>A typical course lasts for 5 weeks.</p> Signup and view all the answers

<p>The risk of lymphoedema is approximately 3%.</p> Signup and view all the answers

<p>The cure rate ranges from 20% to 50%.</p> Signup and view all the answers

<p>Cystitis is a common side effect.</p> Signup and view all the answers

<p>Close surgical margins or involvement of lymph nodes impacts this decision.</p> Signup and view all the answers

<p>Pelvic exenteration may be considered for medically fit patients with advanced central pelvic disease.</p> Signup and view all the answers

<p>Patients should be informed about the implications for future pregnancies and risks of miscarriage.</p> Signup and view all the answers

<p>There is a risk of radiation-induced menopause.</p> Signup and view all the answers

<p>Preoperative imaging is used to minimize the need.</p> Signup and view all the answers

<p>Palliative care focusing on symptom control is generally the approach.</p> Signup and view all the answers

<p>Magnetic resonance imaging (MRI) is the preferred technique.</p> Signup and view all the answers

<p>The cure rates for surgery and chemoradiotherapy are similar.</p> Signup and view all the answers

<p>Follow-up is maintained for at least 5 years with symptomatic enquiries and clinical examinations.</p> Signup and view all the answers

<p>Total pelvic exenteration.</p> Signup and view all the answers

<p>Pelvic lymphadenopathy indicates a higher disease stage, potentially limiting curative options.</p> Signup and view all the answers

<p>An exenterative procedure may be possible in carefully selected patients.</p> Signup and view all the answers

<p>Cervical cancer in pregnancy is rare and has similar survival rates to non-pregnant cases.</p> Signup and view all the answers

<p>Radical hysterectomy (+/-BSO) and pelvic lymphadenectomy.</p> Signup and view all the answers

<p>It serves as a primary treatment approach in patients who are not candidates for surgery.</p> Signup and view all the answers

<p>The presence of lymphovascular space invasion (LVSI).</p> Signup and view all the answers

<p>Larger tumors are associated with lower survival rates.</p> Signup and view all the answers

<p>No further treatment can be considered, depending on follow-up results.</p> Signup and view all the answers

<p>47%.</p> Signup and view all the answers

<p>To preserve fertility in young, nulliparous patients.</p> Signup and view all the answers

<p>Higher likelihood of aggressive disease or inadequate initial treatment.</p> Signup and view all the answers

<p>Assessment of the previous treatment and extent of the recurrence.</p> Signup and view all the answers

<p>MRI scans help assess the extent of the disease and guide treatment decisions.</p> Signup and view all the answers

<p>When the cancer has progressed beyond the possibility of curative treatments.</p> Signup and view all the answers

<p>PET-CT scans and imaging under anaesthesia.</p> Signup and view all the answers

<p>Total pelvic exenteration.</p> Signup and view all the answers

<p>It allows women to retain their fertility.</p> Signup and view all the answers

<p>Widespread recurrence.</p> Signup and view all the answers

<p>Vaginal or trans-abdominal.</p> Signup and view all the answers

<p>Fetal viability issues.</p> Signup and view all the answers

<p>MRI.</p> Signup and view all the answers

<p>Treatment for cervical cancer should proceed without delay.</p> Signup and view all the answers

<p>Attempting vaginal delivery.</p> Signup and view all the answers

<p>NCIC-CTG SHAPE-CX-5 trial.</p> Signup and view all the answers

<p>High morbidity.</p> Signup and view all the answers

<p>A biopsy should be taken under general anesthesia.</p> Signup and view all the answers

<p>Neoadjuvant chemotherapy.</p> Signup and view all the answers

<p>Good obstetrical and oncologic outcomes.</p> Signup and view all the answers

<p>Simple trachelectomy.</p> Signup and view all the answers

<p>A cone biopsy should be performed to ensure complete excision of abnormal tissue and obtain a specimen for pathology.</p> Signup and view all the answers

<p>The stage is IA2 squamous cell carcinoma of the cervix.</p> Signup and view all the answers

<p>Biopsy should be taken from the edge of the tumor to ensure viable tumor cells are sampled.</p> Signup and view all the answers

<p>Close colposcopic and cytological follow-up are required for at least 5 years without further local treatment.</p> Signup and view all the answers

<p>Cervical weakness leading to second-trimester miscarriage and increased risk of caesarean section during labor.</p> Signup and view all the answers

<p>A full blood count, serum urea, and creatinine estimation should be performed.</p> Signup and view all the answers

<p>An ultrasound can be arranged quickly and provides good imaging of hydronephrosis and ureter dilatation.</p> Signup and view all the answers

<p>Surgical disadvantages include risks of hemorrhage, damage to nearby organs, and potential need for subsequent radiotherapy.</p> Signup and view all the answers

<p>MRI is the best imaging method for assessing the extent of the tumor and adjacent structure invasion.</p> Signup and view all the answers

<p>Chemoradiotherapy has a low immediate risk and avoids the need for major surgery.</p> Signup and view all the answers

<p>A punch biopsy should be performed to confirm the diagnosis of cancer.</p> Signup and view all the answers

<p>It confirms the presence of a specific type of cervical cancer that requires targeted treatment.</p> Signup and view all the answers

<p>The patient should be referred for insertion of nephrostomy tubes to alleviate renal dysfunction.</p> Signup and view all the answers

<p>It helps in early detection of any recurrence or progression of disease.</p> Signup and view all the answers

<p>A disease-free margin indicates that the cancerous tissue has been effectively removed.</p> Signup and view all the answers

<p>The treatment usually involves chemoradiotherapy, combining weekly cisplatin and external beam radiotherapy.</p> Signup and view all the answers

<p>The patient should be informed about the extent of her disease, treatment details, and expected outcomes.</p> Signup and view all the answers

<p>Long-term complications may include bowel and bladder problems, including the risk of fistula formation.</p> Signup and view all the answers

<p>Blood transfusions are necessary to address the patient's anemia, which may worsen with chemotherapy.</p> Signup and view all the answers

<p>A simple hysterectomy is a treatment option if there are other indications and if the patient prefers not to preserve fertility.</p> Signup and view all the answers

<p>Blood-stained vaginal discharge is a common symptom associated with cervical cancer.</p> Signup and view all the answers

<p>The woman presented with vaginal bleeding, indicating potential advanced disease.</p> Signup and view all the answers

<p>An examination under anesthesia and subsequent biopsy is necessary for diagnostic confirmation.</p> Signup and view all the answers

<p>Higher BMI increases surgical risks and can affect treatment decisions.</p> Signup and view all the answers

<p>Patients should be informed about potential side effects, including nausea and long-term bowel issues.</p> Signup and view all the answers

<p>A cervical biopsy is indicated to rule out any malignancy despite the benign nature of cervical ectropion.</p> Signup and view all the answers

<p>Reassurance can be provided that cervical ectropion is common and does not indicate cancer.</p> Signup and view all the answers

<p>Chest x-rays are performed to check for pleural effusion or evidence of lung metastases.</p> Signup and view all the answers