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

The rate of new cases of cervical cancer in a population.

The number of deaths from cervical cancer.

A program aimed at reducing cervical cancer cases and deaths in the UK.

Characteristics that increase the chance of developing cervical cancer.

Specialized medical facilities equipped to handle gynaecological cancers like cervical cancer.

The various ways in which cervical cancer can manifest itself.

Diagnostic procedures used in cases of suspected cervical cancer.

Different approaches used in treating women with cervical cancer.

Factors that increase a person's chance of getting cervical cancer.

Starting sexual activity at a young age is a risk factor for cervical cancer.

Smoking increases the risk of cervical cancer, and worsens precancerous conditions.

Human Papillomavirus types 16 and 18 are the most dangerous types of HPV for cervical cancer risk.

Cervical cancer can have no noticeable symptoms in the early stages. Symptoms can include abnormal vaginal bleeding, pain, or discharge.

Regular Pap smears are crucial in detecting cervical cancer early, reducing risk of problems.

A majority of cervical cancers are squamous cell lesions.

Another type of cervical cancer that is less common than squamous cell lesions.

A clinical method, not surgical, for categorizing the spread (stage) of cervical cancer.

A chest X-ray is necessary in cervical cancer staging to check for lung metastasis.

Factors that influence the outcome (prognosis) of cervical cancer treatment

Age of the patient is an important factor in the success of cancer treatments and prognosis.

No currently known genetic predisposition for cervical cancer.

Staging cervical cancer does not always necessitate laparotomy or pelvic lymph node assessment because this is clinical and not surgical.

MRI is used for assessing disease extent before surgery and has higher accuracy compared to examination under anesthesia. However, it is not universally available.

Women who undergo regular 3-yearly smears rarely develop cervical cancer.

Poorer prognosis at all stages of the disease.

Presence of cancer spread to the lymph nodes in the pelvis or near the aorta.

The preferred treatment for stage IIIB cervical cancer.

Can potentially be treated with a simple hysterectomy.

May be sufficient treatment for stage IA, with low nodal spread risk.

Not required in young stage IB patients.

Swelling in the lymph nodes, a recognised side effect of radical surgery.

Approximately 4%, though increased with postoperative radiotherapy.

Approximately 68%.

Reduced cervical cancer incidence by 42% between 1988 and 1997.

Involves bladder removal, not rectum removal.

Early sexual activity, multiple partners, low socioeconomic status, smoking, oral contraceptives, STDs (especially HPV), and immunocompromised states.

Found in over 95% of cases; HPV-16 and HPV-18 are the most common types in the UK.

Automatic HPV testing for borderline/mild dyskaryosis test results; avoids unnecessary treatments.

Post-treatment HPV testing to determine if the infection is cleared, and determine appropriate next assessment steps.

A preventive measure against certain strains of the Human Papillomavirus (HPV) that can cause cervical cancer and genital warts.

A bivalent HPV vaccine targeting HPV-16 and HPV-18, effective in preventing high-grade cervical precancers.

A quadrivalent HPV vaccine including types 6, 11, 16, and 18, preventing high-grade CIN and genital warts.

A precancerous cervical lesion, a precursor to cervical cancer.

Cancer of the cervix, often preceded by precancerous lesions.

Vaccination is best given before sexual debut to be most effective. Ideally done in three doses at 2 and 6 months.

National vaccination program targeting girls aged 12-13. Currently using Gardasil®.

Protection from a disease in a population resulting from the high immunity level in most of that population.

Ongoing testing for the detection and prevention of cervical cancer via cytology or HPV testing.

Approximately 30% of cervical cancer cases are caused by HPV subtypes not covered by vaccines and vaccination does not benefit those already exposed.

Vaccines have generally good safety records, with limited side effects.

Immune responses from HPV vaccines often persist for 5 years, and boosters may be needed but require more time.

Warts of the genital areas, caused by certain strains of HPV, especially types 6 and 11.

Public debate around HPV vaccination, often linked to perceptions of its connection to sexual activity, abstinence, and religious views.

Abnormal Pap smear may indicate invasive disease, but a negative smear doesn't rule out malignancy (cancer).

Cervical cancer staging beyond IA/IA2 relies on clinical assessment (exam under anesthesia).

Clinical staging is inaccurate, with errors ranging significantly depending on the stage.

MRI is superior to CT and clinical exams for determining tumor size and extent.

Surgical staging is the most accurate method but not routinely used unless discrepancy exists between MRI and clinical findings.

Invasive cancer limited to the cervix; microscopic diagnosis; less than 5mm deep and 7mm horizontal extent.

Stromal invasion less than 3 mm and extension less than 7 mm.

Stromal invasion greater than 3 mm but less than 5 mm, with horizontal extent less than 7 mm.

Clinically visible cervical lesions (or pre-clinical) greater than stage IA, limited to the cervix.

Visible cervical lesion less than 4 cm in greatest dimension.

Visible cervical lesion greater than 4 cm in greatest dimension.

Carcinoma beyond the cervix but not reaching pelvic wall or lower vagina third.

Cancer extending beyond the pelvis or involving bladder/rectum mucosa.

Clinical staging has inaccuracies of up to 67% at the most advanced stages (stage IVA).

The majority of cervical cancers develop from squamous cells, the most common type, while a smaller percentage originates from glandular cells.

Cervical cancer staging is based on the extent of the disease, typically determined by pelvic examination under anesthesia and cystoscopy, ideally done by a gynecologic and a clinical oncologist.

Treatment for cervical cancer is coordinated by a multidisciplinary team of specialists, involving surgeons, oncologists, and other healthcare professionals.

The main primary treatment options for cervical cancer are surgery or chemoradiotherapy, both offering comparable cure rates.

The majority of cervical cancer recurrences happen within the first three years after treatment, mainly in the pelvis.

For medically fit, younger patients, surgery (radical hysterectomy and lymph node removal) is preferred. For unfit, older patients, radiotherapy is used. Both offer similar cure rates.

Radical hysterectomy: removal of the uterus, cervix, and surrounding tissues. Bilateral pelvic lymphadenectomy: removal of lymph nodes in the pelvis.

Surgery offers potential for preserving ovarian and sexual function. It also allows accurate staging of the cancer.

Radiotherapy is used for medically unfit patients or when surgery is not suitable. In the UK, it's often combined with cisplatin chemotherapy.

Cisplatin chemotherapy combined with radiotherapy is shown to improve survival rates.

Common side effects include cystitis (bladder inflammation), abdominal discomfort, and diarrhea. These are usually temporary.

Long-term side effects include radiation-induced menopause, vaginal stenosis, and an increased risk of cancer in younger patients.

Radical trachelectomy is a surgery to remove the cervix, paracervical tissue, and lymph nodes, aiming to preserve fertility.

Risks include increased miscarriage, premature delivery, and the need for adjuvant radiotherapy.

Radiotherapy combined with platinum-based chemotherapy is the primary treatment unless the patient is medically unfit.

Cisplatin chemotherapy, when given concurrently with radiotherapy, has been shown to improve survival rates.

Pelvic exenteration is a surgery that removes the tumor and adjacent structures like the bowel, bladder, and vagina. It's used for advanced central pelvic disease with no metastases.

Benefits include potential cure, but risks include high mortality and morbidity. It should only be performed by specialized surgeons at cancer centers.

The focus is on palliation, managing symptoms and improving quality of life since metastasis has occurred.

Palliative radiotherapy can be used to control symptoms like vaginal bleeding.

Usually no further treatment is needed if the excision margins are clear. Close follow-up with cytological and colposcopic examinations is essential.

Uncertainty exists regarding the optimal treatment. Options include modified radical hysterectomy with lymphadenectomy, simple hysterectomy, LLETZ/cone biopsy, or radical radiotherapy for those unfit for surgery.

The incidence of positive lymph nodes in stage IA2 is around 5%, suggesting a small but real risk of spread to nearby lymph nodes.

A team of specialists, including gynaecological oncologists, clinical oncologists, radiologists, and pathologists, meet to discuss the best treatment options for each patient.

Factors influencing treatment decisions include the disease stage, patient age, coexisting medical problems, and individual wishes.

Treatment aims can be either curative, focusing on a long-term cure, or palliative, focusing on managing symptoms and improving quality of life.

Surgery or radical chemoradiotherapy can be used with curative intent and similar success rates for Stage IIA or less advanced cervical cancer.

When possible, a single treatment modality is preferred to minimize complications, particularly with radiotherapy after surgery.

Chemoradiotherapy becomes the primary treatment for more advanced cervical cancer, although surgery can be used for palliative purposes.

Most cervical cancers are of squamous origin, with adenocarcinoma being approximately 20% of cases.

The management of both squamous cell carcinoma and adenocarcinoma is similar, based on the stage of the disease and survival rates.

These procedures are commonly used to diagnose and treat stage IA1 cervical cancer. If the margins are clear, no further treatment is usually required.

Regular cytological and colposcopic monitoring is crucial to detect any potential recurrence after stage IA1 cervical cancer treatment.

A radical surgical procedure removing the uterus, cervix, vagina, rectum, bladder, and surrounding tissues. It's used for advanced, recurrent cervical cancer.

A check-up period after initial treatment, typically months after surgery, to assess the effectiveness of the treatment and detect recurrence.

Surgical procedures to create an opening for stool and urine elimination outside the body, done as part of pelvic exenteration.

A fertility-sparing surgery for cervical cancer, removing the cervix and upper vagina while preserving the uterus for future pregnancy.

A type of stitch that doesn't dissolve in the body, used to close the opening after radical trachelectomy.

Surgical approaches to radical trachelectomy, either through the abdomen or the vagina.

Removal of lymph nodes using minimally invasive laparoscopic surgery, often done during radical trachelectomy.

Chemotherapy given before surgery, used in some cases of cervical cancer to shrink the tumor size.

Cervical cancer diagnosed during pregnancy, requiring specialized management due to fetal viability.

Increased blood supply, making the cervix more prone to bleeding during biopsies in pregnancy.

Cancer spread into the tissues near the cervix, assessed with MRI to determine the extent of the disease.

A surgical procedure to deliver a baby through a vertical incision in the uterus, indicated in some cases of early-stage cervical cancer in pregnancy.

Hormones administered to pregnant women to accelerate fetal lung maturity and reduce complications of preterm delivery.

A meeting involving various medical specialists, such as oncologists, obstetricians, and neonatologists, to discuss the best treatment plan for cervical cancer in pregnancy.

Early stage cervical cancer with potential for worse prognosis if treatment is delayed during pregnancy.

Cervical cancer that has spread beyond the cervix, potentially impacting nearby structures and organs.

Swelling of the kidneys due to blockage of the ureters, the tubes that carry urine from the kidneys to the bladder.

Swelling in both kidneys caused by blocked ureters.

A combined treatment approach involving chemotherapy and radiation therapy.

A form of radiation therapy where radioactive sources are placed directly into or near the tumor.

A chemotherapy drug commonly used to treat various cancers, including cervical cancer.

A condition where red blood cells are smaller than normal.

A protein found in blood that plays a role in maintaining fluid balance and transporting substances.

A tube inserted into the kidney to drain urine, often used to help manage kidney blockage.

A medical doctor specializing in the treatment of cancer.

Radiation therapy where radiation beams are directed at the tumor from outside the body.

A medical setting where multiple specialists collaborate to provide comprehensive patient care.

Total pelvic exenteration is the appropriate treatment for a central recurrence of cervical cancer after radical chemoradiotherapy. This procedure involves removing the tumor, uterus, cervix, bladder, and rectum, and can provide a cure in some cases.

No further treatment is necessary in this case. The patient has already undergone a large loop excision, which has completely removed the high-grade glandular intraepithelial neoplasia and adenocarcinoma.

Total abdominal hysterectomy is the appropriate treatment. This procedure removes the uterus, cervix, and fallopian tubes, and may include removal of the ovaries. The suspected iliac nodes will be examined during surgery to determine if lymph node dissection is needed.

Radical trachelectomy and pelvic lymphadenectomy is typically the treatment of choice in these situations. It allows for the cervix to be removed while preserving the uterus and ovaries, preserving fertility.

Palliative care is the appropriate treatment as the patient has widespread metastatic disease. This focuses on managing symptoms and improving quality of life rather than attempting a cure.

No further treatment is needed. The patient's preinvasive and invasive components were completely excised, making further treatment unnecessary.

Radical hysterectomy (+/-BSO) and pelvic lymphadenectomy is the appropriate treatment. This involves removing the uterus, cervix, and fallopian tubes. Since the patient is in otherwise good health and has no evidence of spread, pelvic lymph node dissection is recommended for staging and prevent recurrence.

The stage of the cervical cancer is the most important prognostic factor. Stage refers to the extent of the cancer's spread and determines the likely outcome of treatment.

The 5-year survival rate for women with Stage I cervical cancer is approximately 79%.

The 5-year survival rate for women with Stage IV cervical cancer is approximately 7%.

The majority of recurrent disease in cervical cancer occurs within the first three years after initial treatment.

Magnetic Resonance Imaging (MRI) is the primary imaging tool for assessing the extent of recurrent disease and identifying possible distant metastases. Other tools like PET-CT can also be utilized to detect occult disease.

Radiotherapy, with or without platinum-based chemotherapy, is the usual treatment for pelvic recurrence of cervical cancer following surgery.

Pelvic exenteration is a surgical procedure to remove the entire pelvic region, including the uterus, cervix, bladder, and rectum, and can be considered for isolated central pelvic recurrence following radiotherapy.

Pelvic exenteration can be anterior (removing the bladder), posterior (removing the rectum), or total (removing both the bladder and rectum) depending on the location and extent of the tumor.

An excision biopsy of the abnormality should be performed, either with a large loop excision of the transformation zone (LLETZ) or a cone biopsy. This allows for the removal of the abnormal tissue while also obtaining a sample for pathological analysis.

Advantages: Provides a specimen for pathological analysis free of diathermy artefact. Disadvantages: Can lead to cervical weakness, painless second-trimester miscarriage, and cervical dystocia, which can result in failure to dilate in labour and a higher risk of caesarean section.

This stage is characterized by an invasive component measuring 7 mm maximal horizontal diameter and depth of 4 mm. There is also a wide margin of disease-free tissue, indicating complete excision of the preinvasive and invasive lesions.

If fertility is desired, there is no requirement for further local treatment after complete excision. Close colposcopic and cytological follow-up is required for at least 5 years. A simple hysterectomy or pelvic lymphadenectomy can be considered depending on individual factors.

Complications include cervical weakness, leading to painless second-trimester miscarriage, and cervical dystocia, which can result in failure to dilate in labour and a higher risk of caesarean section.

Advantages: Preserves sexual function, conserves ovarian function, short treatment with a one-week hospital stay, and few long-term problems. Disadvantages: Haemorrhage, damage to ureter, bowel, bladder, venous thrombosis and pulmonary embolism, lymphoedema, and may require radiotherapy.

Advantages: Low immediate risk, avoids major surgery, and preserves sexual function with the aid of dilators. Disadvantages: Prolonged treatment (6 weeks), loss of ovarian function, nausea and vomiting with chemotherapy, intestinal colic, diarrhoea and cystitis, and long-term bowel and bladder problems including fistula formation.

A punch biopsy should be performed to establish the diagnosis. Additionally, further investigations such as imaging studies (CT scan, MRI) and blood tests may be necessary to assess the extent of the disease and determine the most appropriate treatment plan.

Treatment options include surgery (radical hysterectomy with pelvic lymphadenectomy) and chemoradiotherapy. The most effective treatment depends on the specific characteristics of the patient's tumor and their overall health.

Risks of surgery include haemorrhage, damage to ureter, bowel, bladder, venous thrombosis and pulmonary embolism, lymphoedema, and may require radiotherapy.

Risks of chemoradiotherapy include prolonged treatment (6 weeks), loss of ovarian function, nausea and vomiting, intestinal colic, diarrhoea and cystitis, and long-term bowel and bladder problems including fistula formation.

A fungating carcinoma is a type of cervical cancer that is characterized by a large, fleshy mass that grows outward from the cervix, often appearing as a cauliflower-like growth and may extend into the vaginal wall.

Potential side effects include nausea, vomiting, intestinal colic, diarrhea, cystitis, and long-term bowel and bladder problems such as fistula formation.

A fistula is an abnormal connection between two organs or tissues. In the context of cervical cancer treatment, a fistula can occur between the bowel and bladder, leading to urinary or fecal incontinence.

Regular cervical screening through Pap smears helps detect precancerous changes and early-stage cancer, allowing for timely intervention and increasing the likelihood of a successful treatment outcome.

Complications include cervical weakness leading to painless second-trimester miscarriage, and cervical dystocia, which can result in failure to dilate in labour and a higher risk of caesarean section.