Tuesday, March 9, 2010

Cervical cancer

Cervical cancer - Chronic


 

Definition  

A malignant neoplasm arising from the uterine cervix


 

Initial evaluation of invasive cervical cancer  

* Complete blood count

* Platelet count

* Hepatic function panel

* Measurement of renal function


 

Initial evaluation of invasive cervical cancer (optional for stage IB1 or less)  

* Plain chest X-ray


 

Initial evaluation of invasive cervical cancer (stage IB2 or higher)  

* Endoscopy of bladder

* Proctosigmoidoscopy with biopsy


 

Suspected metastasis from cervical cancer  

* CT of abdomen: Pelvic/abdominal CT is most helpful for evaluating extension of disease beyond the cervix in patients with advanced cancer (stage IIB or higher) .


 

Suspected metastasis from cervical cancer  

* MRI of abdomen: Abdominal/pelvic MRI is most helpful for evaluating extension of disease beyond the cervix in patients with advanced cancer (stage IIB or higher) .


 

Reassessment  

Cervical neoplasia screening  

* Sampling of cervix for Papanicolaou smear: Cervical cancer screening should begin at age 21 years or within 3 years of the onset of sexual activity .


 

Posttreatment surveillance of cervical cancer  

* Complete blood count

* Blood urea nitrogen measurement

* Creatinine measurement

* Plain chest X-ray

* CT of chest

* CT of abdomen

* Positron emission tomography


 

Persistent or recurrent cervical cancer  

* Exploratory incision


 

Medical History  

* HPV - Human papillomavirus test positive

* Sexual behavior finding

* HIV infection

* Smoking

* Hormonal Contraceptive use

* Past medical history of Parity finding

* Estrogen/Progestin Combination use

* Diethylstilbestrol use

* Immune Suppressant use

* Legal, financial, employment and/or socioeconomic history finding


 

Findings  

* Abdominal mass

* Cervix hard

* Edema of leg

* Flank pain

* Hematochezia

* Hematuria

* Hip pain

* Large uterine cervix

* Leg swelling

* Lesion of cervix

* Lower abdominal pain

* Lymphadenopathy

* Pain in buttock

* Respiratory auscultation finding

* Sciatica

* Abnormal vaginal bleeding

* Condyloma acuminatum - Chronic

* Vaginal discharge


 

Tests  


 

Management of certain abnormal cervical cytology results in adults and adolescents  

* Colposcopy of cervix: Colposcopy with endocervical assessment is recommended for select women with cervical cytologic abnormalities and cervical cancer precursors .


 

Abnormal cervical cytology  

* Cervical biopsy: Cervical biopsy should be performed on any visible cervical lesion; endocervical sampling often is done in conjunction with colposcopy .


 

Diagnostic confirmation and possible treatment of cervical intraepithelial neoplasia 2 or 3, adenocarcinoma in situ, or microinvasive cervical cancer  

* Cold knife cone biopsy of cervix: Cold knife conization is the preferred procedure for diagnostic confirmation and possible treatment of microinvasive cervical cancer and adenocarcinoma in situ .


 

Diagnostic confirmation and possible treatment of abnormal cervical cytology or noninvasive cervical intraepithelial neoplasia (CIN) 2 or 3  

* Loop electrosurgical excision procedure: The LEEP may assist in the diagnosis of high-grade squamous intraepithelial lesion cytology results and is a treatment option for cervical intraepithelial neoplasia .


 

Suspected endometrial cancer  

* Endometrial biopsy: Histological information obtained from the endometrial biopsy is generally sufficient for proceeding with definitive treatment .


 

Differential Diagnosis  

* Uterine cancer - Acute

* Polyp of cervix

* Cervicitis

* Uterine leiomyoma - Chronic


 

Treatment  


 

Drug Therapy  


 

First-line chemotherapy for invasive cervical cancer  


 

CISPLATIN


 

CARBOPLATIN  


 

PACLITAXEL  


 

TOPOTECAN HYDROCHLORIDE  


 

Alternative first-line combination chemotherapy for cervical cancer (preferred therapy if cisplatin was previously used as a radiosensitizer)  


 

CISPLATIN - PACLITAXEL  


 


 

CISPLATIN - TOPOTECAN HYDROCHLORIDE  


 


 

CISPLATIN - GEMCITABINE HYDROCHLORIDE  


 


 

CARBOPLATIN - PACLITAXEL  


 


 

Procedural Therapy  


 

Diagnostic confirmation and possible treatment of cervical intraepithelial neoplasia 2 or 3, adenocarcinoma in situ, or microinvasive cervical cancer  

* Cold knife cone biopsy of cervix: Cold knife conization is the preferred procedure for diagnostic confirmation and possible treatment of microinvasive cervical cancer and adenocarcinoma in situ .


 

Diagnostic confirmation and possible treatment of abnormal cervical cytology or noninvasive cervical intraepithelial neoplasia (CIN) 2 or 3  

* Loop electrosurgical excision procedure: The LEEP may assist in the diagnosis of high-grade squamous intraepithelial lesion cytology results and is a treatment option for cervical intraepithelial neoplasia .


 

Treatment of abnormal cervical cytology or cervical intraepithelial neoplasia 2 or 3 when invasive disease has been ruled out  

* Cryotherapy, Cervix uteri structure: Cryotherapy is a treatment option for women with cervical intraepithelial neoplasia 2 or 3 if colposcopy is satisfactory and invasive disease is ruled out .


 

Cervical intraepithelial neoplasia  

* Laser excision of lesion of cervix


 

Treatment of patients with carcinoma in situ or invasive cervical cancer  

* Hysterectomy: Total hysterectomy with or without salpingo-oophorectomy or radical hysterectomy with lymphadenectomy are options for carcinoma in situ and early-stage cervical cancer .


 

Invasive cervical cancer  

* Radiation therapy: Radiotherapy is one of the primary treatment options for most stages of invasive cervical cancer .

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