Task 5

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Task 5

• Mrs WB
• 70 year old lady
• PV spotting for past 5 months
• Otherwise well
• No medications

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Initial Examination

• Pelvic examination
• Examination of the vulva
• Speculum examination vagina and cervix
• Bimanual examination feeling for masses and/or
  tenderness
• ? Rectovaginal examination
• Breast examination
• Abdominal examination
• Respiratory examination

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Investigations for Diagnosis

• Pap smear
• Blood tests FBC, UEC, LFT
• Colposcopy referral
• Direct Bx
• Endocervical curettage
• Transvaginal U/S
• Hysteroscopy
• Endometrial Bx
• Hysteroscopy
• 'Catheter'

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Factors Influencing Management

• Age
• Menopausal status
• Comorbidities
• Histological subtype
• Tumour size
• Results of imaging
• Availability of resources

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Treatment of Stage 1 SCC

• Stage 1a
• Total hysterectomy
• lt3mm deep
• Clear margins on cone Bx
• No vascular or lymphatic channel invasion
• Conization
• If wanting to preserve fertility
• Radical hysterectomy
• 3-5mm deep
• Invasive tumour at margins on cone Bx
• Intracavitary radiation
• lt3mm
• Not surgical candidate

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Treatment of Stage 1 SCC

• Stage 1b
• RTx
• External-beam irradiation
• 2 intracavitary implants
• Radical hysterectomy and bilateral pelvic
  lymphadenectomy
• Rad. Hyster. total pelvic RTx chemotherapy
• ve pelvic nodes/surgical margins residual
  parametrial disease
• RTx chemotherapy
• In patients with bulky tumours
• Radical trachelectomy
• Pelvic nodes, upper vagina, most/all of cervix
  and parametrium
• lt2cm diameter
• Selected patients lt40yrs old