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Table 8. Staging Classification of Cervical Cancer (Clinical Staging)

Stage

Description

0

carcinoma in situ

1 1A 1B

confined to cervix microinvasive all others

2

beyond cervix but not to the pelvic wall, does not involve lower 1/3 of vagina

3 4

extends to pelvic wall, involves lower 1/3 of vagina beyond true pelvis +/– distant spread, bladder, and/or rectum involved

GYNECOLOGICAL ONCOLOGY . . . CONT.

t r e a t m e n t o f a b n o r m a l P a p s m e a r a n d c e r v i c a l c a n c e r C I N 1 ( L G S I L ) o b s e r v e w i t h r e g u l a r c y t o l o g y ( e v e r y 6 m o n t h s ) m a n y l e s i o n s w i l l r e g r e s s o r d i s a p p e a r ( 6 0 % ) c o l p o s c o p y i f p o s i t i v e o n 2 c o n s e c u t i v e s m e a r s l e s i o n s w h i c h p r o g r e s s s h o u l d h a v e a r e a e x c i s e d b y e i t h e r L E E P , l a s e r , c r y o t h e r a p y o r c o n e b i o p s y w i t h L E E P t i s s u e i s o b t a i n e d f o r h i s t o l o g i c a l e v a l u a t i o n C I N 2 a n d C I N 3 ( H G S I L ) L E E P , l a s e r , c r y o t h e r a p y , c o n e e x c i s i o n h y s t e r e c t o m y o n l y f o r C I N 3 w i t h n o d e s i r e f o r f u t u r e c h i l d b e a r i n g S t a g e 1 A c e r v i c a l c o n i z a t i o n i f f u t u r e f e r t i l i t y d e s i r e d s i m p l e a b d o m i n a l h y s t e r e c t o m y i f f e r t i l i t y i s n o t a n i s s u e S t a g e 1 B r a d i c a l ( W e r t h e i m ) h y s t e r e c t o m y a n d p e l v i c o v a r i e s c a n b e s p a r e d S t a g e 2 , 3 , 4 r a d i o t h e r a p y

prognosis • 5 year survival figures • Stage 0: 99% • Stage 1: 75% • Stage 2: 55% • Stage 3: 30% • Stage 4: 7% • Overall: 50-60%

Abnormal Pap Smears in Pregnancy incidence • 1/2200 Pap test and biopsy of any suspicious lesion should be performed at initial prenatal visit (refer to colposcopy) if a diagnostic conization is required it should be deferred until T2 to prevent complications (abortion) microinvasive carcinoma • followed to term and delivered vaginally or by cesarean section depending on degree of invasion stage 1B carcinoma • depending on patient wishes • recommendations in T1 for external beam radiation with the expectations of spontaneous abortion • recommendations in T2, delay of therapy until viable fetus and delivery follow-up with appropriate treatment

Notes

MCCQE 2000 Review Notes and Lecture Series

Gynecology 41

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