Consultant Medical Oncologist BEFORE START OF TREATMENT Learning Objectives Treatment latest guidelines and updates Prevention Treatment Is by Stage Examination Under Anesthesia Contrast enhanced MRI Pelvis ID: 1044759
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1. CERVICAL CARCINOMADr Shanzah ShahbazConsultant Medical Oncologist
2. BEFORE START OF TREATMENT
3. Learning Objectives:Treatment ( latest guidelines and updates)Prevention
4. Treatment Is by Stage Examination Under AnesthesiaContrast enhanced MRI PelvisContrast enhanced CT Scan Chest, abdomenCystoscopy/Proctoscopy ( For suspicion of bladder/bowel involvement with biopsy is required)FIGO Staging Complete staging workup before start of treatment is mandatory.
5. Treatment is same for both squamous cell and adenocarcinoma of cervixTreatment modalities Surgery 1. Hysterectomy , pelvic lymph node dissection with or without paraaortic dissection 2. Conization ( with neagtive margins of 1mm) with lymph node dissection 3.Trachelectomy with lymph node dissection Sentinel Lymph node biopsy can be used for stage 1 cervical cancers Radiation therapy External radiation( 40 – 45 Gy with 10-20 Gy boost) and Brachytherapy ( 5.5 Gy X 2 fractions or 6 Gy x 3 fractions)
6. Sedlis criteria and (margin, lymph node and parametria status )used to decide for adjuvant radiation vs concomitant chemoradiation. Chemotherapy 1. platinum based doublets +/- bevacizumab 2. Platinum based doublet plus pembrolizumab 3.Cisplatin used concomitantly with radiation ( locally advanced cancer IIB – IVA )
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8. RECENT ADVANCESImmunotherapy leads to improved Progression free survival and Overall survivalMetastatic and recurrent unresectable cervical cancer Check PDL-1 Status PDL-1 positive…….Pembrolizmab+ platinum + Paclitaxel PDL-1 Negative…..Bevacizumab+ Platinum+ PaclitaxelAntibody drug conjugate, Tisotumab vedotin-tftv is the new class of drug recently added
9. IS PREVENTION OF CERVICAL CANCER POSSIBLE ???
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11. IF YOU COULD END CANCER, WILL YOU?
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