Devita, Hellman, and Rosenberg's Cancer

LWBK1006-23 LWW-Govindan-Review December 12, 2011 19:10

324 DeVita, Hellman, and Rosenberg’s CANCER: Principles and Practice of Oncology Review

Answer 23.2.9. The answer is C.

HPV infections are not rare, and although promiscuity is more common

for women with cervical cancer, it is certainly not required. There is no

currently effective antiviral therapy that is active against HPV. Treatments

of the precancerous and cancerous changes that develop from HPV are

usually indicated, but the virus can still be often detected even after ther-

apy. An HPV vaccine has recently been FDA approved as a preventative

vaccine. It appears that primarily those patients who are naive to the

virus benefit from vaccination. Young women between the ages of 9 and

26 years are currently approved for vaccination. Ideally, vaccination

should occur before the onset of sexual activity.

Answer 23.2.10. The answer is C.

All of the factors are correct except that current antiretroviral therapy

has not demonstrated benefit against HPV.

Answer 23.2.11. The answer is B.

The incidence of nodal (extracervical) involvement is directly correlated

with tumor stage, size, histology, depth of invasion, and lymphovascular

space invasion. For patients with stage I disease treated with radical

hysterectomy, 15% to 20% and 1% to 5% of pelvic and para-aortic

lymph nodes, respectively, will be involved. Cervical cancer usually

follows an orderly pattern of spread from the cervix to the pelvic nodes,

then to the common iliacs, and finally to the para-aortic lymph nodes

before systemic spread. Distant metastatic sites can occur, and the most

common are lung, extrapelvic lymph nodes, liver, and bone.

Answer 23.2.12. The answer is D.

Microinvasive carcinoma of the cervix is often a source of confusion and

mismanagement for patients with cervical cancer. Patient with stage IA1

cancers have been safely managed with conization only or simple hys-

terectomy. These patients typically are not treated with radiation and

chemotherapy. The difficulty and confusion that arise result from practi-

tioners attempting to make the diagnosis from small biopsies. To make

the diagnosis, the patient should have less than 3 mm of invasion and

no more than 7 mm of lateral spread, along with negative margins. LVSI

remains controversial, but typically if present, patients should be treated

as if they have frankly invasive disease. Thus, if superficial invasion is seen

on a small biopsy and there is no visible tumor on the cervix, the patient

should typically be evaluated with cervical conization before definitive

therapy to properly stage the patient and allow for the most appropriate

therapy.

Answer 23.2.13. The answer is B.

Staging of cervical cancer is clinical, which is based on careful clin-

ical examination and routine radiographic studies (e.g., chest radio-

graph, intravenous pyelogram, lower gastrointestinal) and procedures