Chrisandra Shufelt, MD, on using a cardiovascular risk score to guide hormone therapy candidacy at menopause.
|Articles|August 3, 2011
Cancer of the Uterine Corpus and Cervix
Author(s)David B. Toub, MD
Many physicians are discouraged with the results of cancer thereapy. However, the opportunity is there for all physicianst o make an early diagnosis in all the gynecologic cancers except those in the tube and ovary. Stage for stage, little progress has been made in lowering mortality rates, but the overall mortality rate is decreasing because more patients are having their cancers diagnosed in early states of disease. This achievement is to the everlasting credit of the practicing doctors who have, by training and motivation, been successful in establishing early diagnosis as a protection for the women of the United States. Those women saved from the raves of cancer shall call their physicians blessed.
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Incidence
Mortality
Corpus
32,000
4400
Ovary
21,000
13,000
Cervix
13,500
5,600
Other
4,500
1000
Cervix
Corpus
HPV
Hyperestrogenism
Smoking
Nulliparity
Immunosuppression
Hypothyoidism
Low beta-carotene intake
Obesity
Diabetes
Atypical Hyperplasia
Cervix
Corpus
Squamous Cell (85%)
Endometrioid AdenoCA(80%)
Adenocarcinoma
Papillary Serous AdenoCA
Clear Cell
Clear Cell AdenoCA
Mesonephric
Squamous Cell
Sarcomas
(LMS,ESS,MMMT)
Cervix
Corpus
Clinical
Surgical
0:
Carcinoma-in-situ
Ia:
Microinvasive
Ib:
Invasive (>5mm FIGO, >3 SGO)
IIa:
Upper 2/3 of vagina
IIb:
Paremtrial involvement (not to PSW)
IIIa:
Lower 1/3 of vagina
IIIb:
PSW or hydronephrosis/nonfunctional kidney
IVa:
Bladder or rectal mucosa
IVb:
Distant metastases
Cervical CA
•Pelvic exam
•CXR
•SMA-7
•Cystoscopy
•Proctoscopy
•IVP
•Not allowed: MRI, CT, ly
Staging Techniques:
Lymphangiography, surgical findings
PREINVASIVE LESIONS:
Cervix
•SIL
(W/U by colposcopy)
•Tx: CO2 Laser,
LEEP,Cryosurgery
asive Lesions:
Corpus
•Atypical Hyperplasia
(W/U by EMBx, D+C/hysts)
•Tx: Progestins,
hysterectomy,?GnRH-a
•
Removes corpus, cervix, parametria, upper third of vagina
•
Uterine arteries divided at origin
•
Ureters dissected through tunnel
•
Uterosacral ligaments divided near rectum
•
Typically combined with LND
•
Oophorectomy not mandated
•
Bladder/rectal dysfunction
•
Lymphocyst/lymphedema
•
Urethral strictures
•
Ureterovaginal fistula
ACUTE
CHRONIC
• Perforation
• Proctitis
• Fever
• Cystitis (a/w UTI)
• Diarrhea
• Fistula
• Bladder spasm
• Enteritis
Ia
Limited to endometrium
Ib
< 1/2 mymoetrial thickness
Ic
> 1/2 mymoetrial thickness
IIa
Cervical glandular involvement
IIb
Cervical stromal involvement
IIIa
Uterine serosa, positive washings, or adnexal involvement
IIIb
Vaginal metastases
IIIc
Postive lymph nodes
IVa
Bladder or bowel mucosa
IVb
Distant metastases
•
Surgical staging in majority of patients (Extrafascial TAH/BSO, washings, +/- LND)
•
No adjuvant RT if Ia, G1-2 (Ib 1-2) with favorable histology
•
Adjuvant RT for High-risk pts
•
Progestins not useful for primary dz
•
Chemo does not appear to be helpful
•
Deep myometrial invasion
•
Positive nodes
•
Grade 3 tumor
•
Clear cell, papillary serous, squamous or undifferentiated histologies
•
Positive peritoneal cytology
•
Other extra-uterine spread
•
Surgical staging
•
Single-agent chemotx, depending on histology and stage (ADR for LMS, ESS; IFX for MMMT)
•
RT does not appear to alter survival
Many physicians are discouraged with the results of cancer thereapy. However, the opportunity is there for all physicianst o make an early diagnosis in all the gynecologic cancers except those in the tube and ovary. Stage for stage, little progress has been made in lowering mortality rates, but the overall mortality rate is decreasing because more patients are having their cancers diagnosed in early states of disease. This achievement is to the everlasting credit of the practicing doctors who have, by training and motivation, been successful in establishing early diagnosis as a protection for the women of the United States. Those women saved from the raves of cancer shall call their physicians blessed.
- Barber, 1980
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