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wolverine
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Joined: 16 Jan 2007
Posts: 394
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 Posted: Thu Feb 01, 2007 5:41 pm Post subject: Oncology-Cervical Ca |
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1 staging of cervical Ca requires MRI imaging
2. the possibility of positive pelvic nodes in stage 1a2 is very low (<1%) and therefore lymhadenectomy is not advisable
3. The overall survival rate is about 60%
4. Chemo-radiotherapy has better outcomes than radiotherapy alone.
5. Surgery has better outcome than chemoradiation in stage IIa
6. If diagnosed in pregnancy after 28 weeks, delivery by LSCS and caesarean radical hysterectomy is adviced in early disease. |
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wolverine
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Joined: 16 Jan 2007
Posts: 394
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| Posted: Thu Feb 01, 2007 5:42 pm Post subject: |
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| I'll be back with some more cancers soon! Let me study first |
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vani s
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Joined: 20 Jan 2007
Posts: 141
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| Posted: Thu Feb 01, 2007 6:23 pm Post subject: |
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1 staging of cervical Ca requires MRI imaging
definetely not.
2. the possibility of positive pelvic nodes in stage 1a2 is very low (<1%) and therefore lymhadenectomy is not advisable
false
3. The overall survival rate is about 60%
guess true...
4. Chemo-radiotherapy has better outcomes than radiotherapy alone.
 not sure..
5. Surgery has better outcome than chemoradiation in stage IIa
false
6. If diagnosed in pregnancy after 28 weeks, delivery by LSCS and caesarean radical hysterectomy is adviced in early disease.
false |
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rpwalavalkar
Teale Fenning Administrator
Joined: 20 Jul 2006
Posts: 966
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| Posted: Thu Feb 01, 2007 7:14 pm Post subject: Re: Oncology-Cervical Ca |
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| wolverine wrote: | | 1 staging of cervical Ca requires MRI imaging. |
TRUE In patients with cervical cancer, MRI is superior to CT and clinical examination for evaluating uterine body involvement and measuring tumor size, but no method was accurate for evaluating cervical stroma.
Ref -- Mitchell DG, Snyder B, Coakley F, Reinhold C, Thomas G, Amendola M, Schwartz LH, Woodward P, Pannu H, Hricak H. Early invasive cervical cancer: tumor delineation by magnetic resonance imaging, computed tomography, and clinical examination, verified by pathologic results, in the ACRIN 6651/GOG 183 Intergroup Study. J Clin Oncol, Vol. 24, No. 36. (20 December 2006), pp. 5687-5694.
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Dr Miss. Raj Walavalkar MBBS MRCOG
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rpwalavalkar
Teale Fenning Administrator
Joined: 20 Jul 2006
Posts: 966
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| Posted: Thu Feb 01, 2007 7:28 pm Post subject: Re: Oncology-Cervical Ca |
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| wolverine wrote: | | 2. the possibility of positive pelvic nodes in stage 1a2 is very low (<1%) and therefore lymhadenectomy is not advisable. |
FALSE
my logic behind this is that during radical trachelectomy we do try and get a local clearence along with nodes especially if tumor is 2 cm or more.
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Dr Miss. Raj Walavalkar MBBS MRCOG
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rpwalavalkar
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Joined: 20 Jul 2006
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| Posted: Thu Feb 01, 2007 7:30 pm Post subject: Re: Oncology-Cervical Ca |
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| wolverine wrote: | | 3. The overall survival rate is about 60% |
TRUE
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Dr Miss. Raj Walavalkar MBBS MRCOG
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rpwalavalkar
Teale Fenning Administrator
Joined: 20 Jul 2006
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| Posted: Thu Feb 01, 2007 7:38 pm Post subject: Re: Oncology-Cervical Ca |
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| wolverine wrote: | | 4. Chemo-radiotherapy has better outcomes than radiotherapy alone. |
TRUE
2001 cochrane review.
cisplatin is used with radiation.
chemo-rad can't be offered in the foll circumstances---
1a and 1b1 -- as successful treatment with surgery
4b -- as distant mets present - lungs/ hepatic
if patient has renal failure.
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Dr Miss. Raj Walavalkar MBBS MRCOG
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SR O&G Wessex Region |
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rpwalavalkar
Teale Fenning Administrator
Joined: 20 Jul 2006
Posts: 966
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| Posted: Thu Feb 01, 2007 7:51 pm Post subject: Re: Oncology-Cervical Ca |
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| wolverine wrote: | | 5. Surgery has better outcome than chemoradiation in stage IIa. |
TRUE
my logic is --
chemoradiation will be associated with longterm radio morbidity.
surgery will reduce tumor bulk.
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Dr Miss. Raj Walavalkar MBBS MRCOG
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SR O&G Wessex Region |
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rpwalavalkar
Teale Fenning Administrator
Joined: 20 Jul 2006
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| Posted: Thu Feb 01, 2007 8:01 pm Post subject: Re: Oncology-Cervical Ca |
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| wolverine wrote: | | 6. If diagnosed in pregnancy after 28 weeks, delivery by LSCS and caesarean radical hysterectomy is adviced in early disease. |
TRUE
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Dr Miss. Raj Walavalkar MBBS MRCOG
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SR O&G Wessex Region |
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wolverine
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Joined: 16 Jan 2007
Posts: 394
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| Posted: Thu Feb 01, 2007 9:56 pm Post subject: |
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Nick. As you noticed I posted the topic number 100! What do I get?    |
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EMAK
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Joined: 26 Nov 2006
Posts: 572
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| Posted: Thu Feb 01, 2007 10:19 pm Post subject: Re: Oncology-Cervical Ca |
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| rpwalavalkar wrote: | | wolverine wrote: | | 6. If diagnosed in pregnancy after 28 weeks, delivery by LSCS and caesarean radical hysterectomy is adviced in early disease. |
TRUE |
I agree with nice answers of Raj
I just want to add here that it is better to give antenatal corticosteroid with transfer to tertiary center with good neonatal fasilities..
vaginal delivery is contraindicated because lead to vascular and lymphatic spread...  |
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wolverine
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Joined: 16 Jan 2007
Posts: 394
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| Posted: Fri Feb 02, 2007 12:08 am Post subject: |
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| Quote: | | vaginal delivery is contraindicated because lead to vascular and lymphatic spread... |
Cervical cancer spreads by direct invasion or lymphatic permeation. Vaginal delivery could have a place for advanced disease but there is a significant risk of bleeding therefore C/S is indicated as well as in early disease. |
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wolverine
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Posts: 394
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| Posted: Fri Feb 02, 2007 12:12 am Post subject: |
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Any other offers? Shall I give the answers I have? Hint: So far Vani has the highest score! (sorry Raj  ) |
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Nick Raine-Fenning
Course Director
Joined: 27 May 2006
Posts: 1852
Location: Nottingham
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| Posted: Fri Feb 02, 2007 12:41 am Post subject: Re: Oncology-Cervical Ca |
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Let me have a go and please remember it is very late (02.00 in Barecelona  )
| wolverine wrote: | | 1 staging of cervical Ca requires MRI imaging |
False - it is not part of FIGO staging
| wolverine wrote: | | 2. the possibility of positive pelvic nodes in stage 1a2 is very low (<1%) and therefore lymhadenectomy is not advisable |
Not sure but probably true
| wolverine wrote: | | 3. The overall survival rate is about 60%. |
Sounds right for all cancers although may be a little higher?
| wolverine wrote: | | 4. Chemo-radiotherapy has better outcomes than radiotherapy alone. |
True
| wolverine wrote: | | 5. Surgery has better outcome than chemoradiation in stage IIa |
Aren't they equivalent?
| wolverine wrote: | | 6. If diagnosed in pregnancy after 28 weeks, delivery by LSCS and caesarean radical hysterectomy is adviced in early disease. |
Yes for the reasons Wolvrine suggested.
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EMAK
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Joined: 26 Nov 2006
Posts: 572
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| Posted: Fri Feb 02, 2007 8:41 am Post subject: |
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| wolverine wrote: | | Quote: | | vaginal delivery is contraindicated because lead to vascular and lymphatic spread... |
Cervical cancer spreads by direct invasion or lymphatic permeation. Vaginal delivery could have a place for advanced disease but there is a significant risk of bleeding therefore C/S is indicated as well as in early disease. |
Will you deliver her vaginally ..then do radical hysterectomy after peurperium??!!!!!! |
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wolverine
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Joined: 16 Jan 2007
Posts: 394
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| Posted: Fri Feb 02, 2007 12:35 pm Post subject: |
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| Radical Hysterectomy is not the treatment of choice in advanced disease!! |
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EMAK
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Joined: 26 Nov 2006
Posts: 572
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| Posted: Fri Feb 02, 2007 3:45 pm Post subject: |
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Ok let us say: what will be the management options in the following patients:
1-patient with cervical cancer stage 2b..28 weeks gestaion...
2-patient with advanced stage of cervical cancer and 28 weeks gestaion...
3-20 weeks gestaion...with CIN 3... |
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bronwyn
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Joined: 19 Jul 2006
Posts: 144
Location: Alton, Hampshire
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| Posted: Fri Feb 02, 2007 5:23 pm Post subject: |
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In answer to Wolverine's questions:
FFTTFF
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Bronwyn Bell
SpR
Portsmouth |
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wolverine
Century Club
Joined: 16 Jan 2007
Posts: 394
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| Posted: Fri Feb 02, 2007 6:03 pm Post subject: |
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100% Bronwyn!
1. It would be true if it was for HPV-16
2. Stage Ia2 risk for pelvic lymphnodes involvement is 5% therefore lymphadenectomy is adviced
3. just true
4. just true
5. the 5-year survival rate is the same between surgery and chemo-radio
6. The wrong bit in this otherwise correct statement is the LSCS. Classical section is adviced   |
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wolverine
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Joined: 16 Jan 2007
Posts: 394
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| Posted: Fri Feb 02, 2007 6:13 pm Post subject: |
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With regards to EMAK's q. 1 and 2 are the same as IIb is considered advanced and the management should be C/S to avoid bleeding and post-op chemo-rediation
CIN3 at 20 weeks (who did that biopsy at 20 weeks?!) needs an experienced colposcopist to exclude invasion in her colp follow up in 3rd trimester (early) and another one 3/12 post partum |
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