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Do vaccinated individuals still need to get Pap smears
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Section II: Topics in Gynecology
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SQUAMOUS CELL CARCINOMA OF THE CERVIX
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Who gets squamous cell carcinoma (SCC) of the cervix What are the five prognostic indicators for SCC There is a bimodal age distribution with peaks between 35 and 40 and between 60 and 65 1 2 3 4 5 Stage of disease (most important) Lymph node involvement Tumor size Depth of stromal invasion Invasion of lymphovascular space
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What are the treatment options for invasive SCC of the cervix and what are the indications of each
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1 Cervical conization: used for women with stage Ia1 with no involvement of the lymphovascular space who wish to preserve fertility 2 Radical trachelectomy: involves surgical removal of the cervix and parametria and placement of a cerclage, and can be combined with a laparoscopic or open diagnostic/therapeutic lymphadenectomy with para-aortic lymph node sampling; used for women with stage Ia1 with involvement of the lymphovascular space, stage Ia2 or Ib1 disease who wish to preserve fertility 3 Radical hysterectomy: used for premenopausal women with early stage (up to stage IIa) cervical cancer who wish to preserve ovarian function 4 Chemoradiotherapy alone: used for women with stage Ia, Ib, or IIa cancer who are poor surgical candidates or who decline a surgical approach Chemoradiotherapy versus surgery for Ib2 is controversial 5 Chemoradiotherapy and hysterectomy: women with advanced disease Can be done via: a Chemoradiotherapy followed by hysterectomy b Neoadjuvant chemotherapy followed by hysterectomy and, if indicated, radiation
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5: Gynecologic Oncology
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c Hysterectomy followed by chemoradiotherapy *This is rarely an ideal choice as the morbidity is increased when this combination is used Patients with locally advanced disease should be treated with primary chemoradiotherapy Women with PID, another pelvic mass, or anatomic alterations should be treated with primary hysterectomy What is the recommended treatment for each of the following stages of cervical cancer Ia1: Conization or simple hysterectomy Ia2 early IIb: Radical hysterectomy with a pelvic lymphadenectomy or chemoradiotherapy Late IIb IV: Chemoradiotherapy or combination chemotherapy Patients with any two of the following risk factors should be considered candidates for adjuvant radiotherapy without chemotherapy: large tumor size; deep stromal invasion; lymphovascular space invasion If a patient has any of the following: Positive resection margins Positive lymph nodes Parametrial involvement What types of chemotherapy are used for cervical cancer treatment and how do they work Cisplatin with or without 5-FU Cisplatin is a cycle-nonspecific alkylating agent that cross-links DNA 5-FU is a cycle-specific DNA synthesis inhibitor
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What are the indications for adjuvant radiotherapy without chemotherapy
What are the indications for adjuvant chemoradiotherapy
What are the main side effects of the following Cisplatin: 5-FU: The two main methods of radiation delivery for cervical cancer are external photon beam radiation therapy (RT) and intracavitary brachytherapy When is each indicated Leukopenia, ototoxicity, nephrotoxicity, and peripheral neuropathy Fatigue, diarrhea, nausea, vomiting, and myelosuppression Intracavitary brachytherapy alone is adequate treatment for stage Ia1 disease, external beam RT is generally added to brachytherapy to improve pelvic control with more advanced
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Section II: Topics in Gynecology
disease, such as stage Ib and IIa disease What are the side effects of radiation Acute side effects: nausea, diarrhea, and skin damage Long-term complications: cystitis, proctitis, vaginal foreshortening, stenosis, and dryness (which leads to sexual dysfunction), development of fistulae, small bowel obstruction What are the complications of surgery Postoperative complications: hemorrhage, fever, sepsis, pulmonary embolus, and infection Long-term complications: bladder dysfunction, strictures of the ureter, lymphocyst formation, and fistula formation What type of surveillance is indicated in posttreatment for SCC Patients need to be evaluated every 3 months for the first 2 years after treatment After these 2 years, they must be seen every 4 months in the third year, every 6 months for 5 years, and annually thereafter These evaluations must include careful attention to the supraclavicular and inguinal lymph nodes, a rectovaginal examination, and an abdominal examination A Pap smear must be done at each visit Depends on patient and presentation, however in general, patients who were initially surgically treated may receive radiotherapy Patients initially treated with radiotherapy may be surgically treated if their recurrence is localized or they may receive chemotherapy
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