2005-01-26 20:24:03暈炫
cervical cancer
Cervical cancer
Risk
1. 35~60 y/o, pre-menopausal woman
2. HPV
3. Smoking
4. Early intercourse, multiple partners
Symptoms
1. Abnormal uterine bleeding
2. Intermenstrual bleeding
3. 5% of total cancer
Pap smear
1. Fixed with 95% alcohol & 醚, 1:1
2. Keep in wet, NOT DRY
财 Annual check up was recommended
Schiller’s test
财 Malignant cell: no glycogen, no color change
Acetic acid
财 Malignant cell: much protein due to high chromattin ratio, become white
Cytological classification of pap smear
Stage 1 : normal
Stage 2 : atypia
Stage 3 : similar to malignant
Stage 4 : malignant cell(+)
Stage 5 : malignant change
Stage
CIS: H-SIL, no involvement beyond stroma
I: confined in cervix
IA: microscopic
IA1: depth < 7mm width < 3mm
IA2: depth < 7mm width = 3 ~ 5 mm
IB: macroscopic
IB1: mass < 4 cm
IB2: mass > 4 cm
II: not involved to pelvic cavity
IIA: invovled to U+M/3 of vagina
IIB: involved to parametrium
3: pelvic cavity, L/3 vagina, hydronephrosis
IIIA: L/3 vagina
IIIB: pelvic wall or hydronephrosis
4: distant meta
IVA: involved to bladder or rectum
IVB: distant meta
PS. Surgical outcome did not change the clinical staging of cervical cancer
PS: extended via (1) direct invasion (2) LN spreading
PS. Pre-Invasive to Invasive cervix cancer: 4 years
PS: easy early bone METs
The main cause of death in terminal cervical cancer
财 Uremia due to severe hydronephrosis
Complication of cauterization
财 Delay bleeding, acute cervicitis
财 Cervix stenosis, Cervix incompetence
Complication of surgery
财 Radical hysterectomy: 膀胱無力
财 Fistula: uretero-vaginal fistula
Onset of MTX toxicity
财 2~4 weeks after administration of MTX
Metastasis of cervical cancer
财 LN: L/3 vagina’s LN system was via inguinal LN
财 Percentage of LN meta in different stage of cervical cancer (15-30-45)
财 Primary group of LN meta in cervical cancer patient
财 mainly via internal iliac group *
财 parametrial, obturator, hypogastric,, uteral *
财 Stromal invasion < 1mm, incidence of LN meta = 2%
Radiotherapy
财 Absolute contraindication: severe pelvic inflammation
财 Dose of R/T in cervical cancer, 7 ~ 8K
财 Common complications: cystitis & proctitis
财 Post R/T cervix Maturation Index(MI)
* 100/0/0 *, * parabasal/intermecliate/superficial *
财 Prognosis: the same as surgery in Stage Ib
财 Radiotherapy only if stage IIB or 以上
财 The rate of radioresistance = 0 ~ 5%
财 Radiosensitive C/T agent = vincristine, bleomycin, hydroxyurea, mitomycin-C
财 Prognostic factor: tumor size
财 Adventage of afterloading tech: reduce exposure of radiation
财 Point A: lateral 2 cm from lesion dose: 6,000 ~ 6,500 rad
Point B: lateral 5 cm from lesion dose: 5,000 ~ 5,500 rad (obturator gr.)
财 Regimen: Ra-226 Radium(強), Cs-137 Cesium(弱)
财 For adenocarcinoma of cervix: best therapy: neoajuvant R/T + OP
Cervical cancer in pregnancy
财 Prognosis: worser than non-pregnancy
财 CIN: could be treated after delivery
财 Invasive cancer
1. < 24 wks: artificial abortion and began Tx
2. > 24 wks: C/S, NOT NSD
Risk
1. 35~60 y/o, pre-menopausal woman
2. HPV
3. Smoking
4. Early intercourse, multiple partners
Symptoms
1. Abnormal uterine bleeding
2. Intermenstrual bleeding
3. 5% of total cancer
Pap smear
1. Fixed with 95% alcohol & 醚, 1:1
2. Keep in wet, NOT DRY
财 Annual check up was recommended
Schiller’s test
财 Malignant cell: no glycogen, no color change
Acetic acid
财 Malignant cell: much protein due to high chromattin ratio, become white
Cytological classification of pap smear
Stage 1 : normal
Stage 2 : atypia
Stage 3 : similar to malignant
Stage 4 : malignant cell(+)
Stage 5 : malignant change
Stage
CIS: H-SIL, no involvement beyond stroma
I: confined in cervix
IA: microscopic
IA1: depth < 7mm width < 3mm
IA2: depth < 7mm width = 3 ~ 5 mm
IB: macroscopic
IB1: mass < 4 cm
IB2: mass > 4 cm
II: not involved to pelvic cavity
IIA: invovled to U+M/3 of vagina
IIB: involved to parametrium
3: pelvic cavity, L/3 vagina, hydronephrosis
IIIA: L/3 vagina
IIIB: pelvic wall or hydronephrosis
4: distant meta
IVA: involved to bladder or rectum
IVB: distant meta
PS. Surgical outcome did not change the clinical staging of cervical cancer
PS: extended via (1) direct invasion (2) LN spreading
PS. Pre-Invasive to Invasive cervix cancer: 4 years
PS: easy early bone METs
The main cause of death in terminal cervical cancer
财 Uremia due to severe hydronephrosis
Complication of cauterization
财 Delay bleeding, acute cervicitis
财 Cervix stenosis, Cervix incompetence
Complication of surgery
财 Radical hysterectomy: 膀胱無力
财 Fistula: uretero-vaginal fistula
Onset of MTX toxicity
财 2~4 weeks after administration of MTX
Metastasis of cervical cancer
财 LN: L/3 vagina’s LN system was via inguinal LN
财 Percentage of LN meta in different stage of cervical cancer (15-30-45)
财 Primary group of LN meta in cervical cancer patient
财 mainly via internal iliac group *
财 parametrial, obturator, hypogastric,, uteral *
财 Stromal invasion < 1mm, incidence of LN meta = 2%
Radiotherapy
财 Absolute contraindication: severe pelvic inflammation
财 Dose of R/T in cervical cancer, 7 ~ 8K
财 Common complications: cystitis & proctitis
财 Post R/T cervix Maturation Index(MI)
* 100/0/0 *, * parabasal/intermecliate/superficial *
财 Prognosis: the same as surgery in Stage Ib
财 Radiotherapy only if stage IIB or 以上
财 The rate of radioresistance = 0 ~ 5%
财 Radiosensitive C/T agent = vincristine, bleomycin, hydroxyurea, mitomycin-C
财 Prognostic factor: tumor size
财 Adventage of afterloading tech: reduce exposure of radiation
财 Point A: lateral 2 cm from lesion dose: 6,000 ~ 6,500 rad
Point B: lateral 5 cm from lesion dose: 5,000 ~ 5,500 rad (obturator gr.)
财 Regimen: Ra-226 Radium(強), Cs-137 Cesium(弱)
财 For adenocarcinoma of cervix: best therapy: neoajuvant R/T + OP
Cervical cancer in pregnancy
财 Prognosis: worser than non-pregnancy
财 CIN: could be treated after delivery
财 Invasive cancer
1. < 24 wks: artificial abortion and began Tx
2. > 24 wks: C/S, NOT NSD