Cancer of the Uterine Corpus and Cervix

August 3, 2011

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.


 IncidenceMortality
Corpus32,0004400
Ovary21,00013,000
Cervix13,5005,600
Other4,5001000


CervixCorpus
HPVHyperestrogenism
SmokingNulliparity
ImmunosuppressionHypothyoidism
Low beta-carotene intakeObesity
 Diabetes
 Atypical Hyperplasia


CervixCorpus
Squamous Cell (85%)Endometrioid AdenoCA(80%)
AdenocarcinomaPapillary Serous AdenoCA
Clear CellClear Cell AdenoCA
MesonephricSquamous Cell
 Sarcomas (LMS,ESS,MMMT)


CervixCorpus
ClinicalSurgical


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


ACUTECHRONIC
• Perforation• Proctitis
• Fever• Cystitis (a/w UTI)
• Diarrhea• Fistula
• Bladder spasm• Enteritis



IaLimited to endometrium
Ib< 1/2 mymoetrial thickness
Ic> 1/2 mymoetrial thickness
IIaCervical glandular involvement
IIbCervical stromal involvement
IIIaUterine serosa, positive washings, or adnexal involvement
IIIbVaginal metastases
IIIcPostive lymph nodes
IVaBladder or bowel mucosa
IVbDistant 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