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.
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.
