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Chapter 093. Gynecologic Malignancies (Part 8)

Clinical Presentation and Staging Patients with cervix cancer generally are asymptomatic, and the disease is detected on routine pelvic examination. Others present with abnormal bleeding or postcoital spotting that may increase to intermenstrual or prominent menstrual bleeding. Yellowish vaginal discharge, lumbosacral back pain, lower-extremity edema, and urinary symptoms may be present. The staging of cervical carcinoma is clinical and generally completed with a pelvic examination under anesthesia with cystoscopy and proctoscopy. Chest xrays, intravenous pyelograms, and CT are generally required, and MRI may be used to assess extracervical extension. . | Chapter 093. Gynecologic Malignancies Part 8 Clinical Presentation and Staging Patients with cervix cancer generally are asymptomatic and the disease is detected on routine pelvic examination. Others present with abnormal bleeding or postcoital spotting that may increase to intermenstrual or prominent menstrual bleeding. Yellowish vaginal discharge lumbosacral back pain lower-extremity edema and urinary symptoms may be present. The staging of cervical carcinoma is clinical and generally completed with a pelvic examination under anesthesia with cystoscopy and proctoscopy. Chest x-rays intravenous pyelograms and CT are generally required and MRI may be used to assess extracervical extension. Stage 0 is carcinoma in situ stage I is disease confined to the cervix stage II disease invades beyond the cervix but not to the pelvic wall or lower third of the vagina stage III disease extends to the pelvic wall or lower third of the vagina or causes hydronephrosis and stage IV is present when the tumor invades the mucosa of bladder or rectum or extends beyond the true pelvis Fig. 93-1 . Five-year survivals by stage are stage I 85 stage II 65 stage III 35 and stage IV 7 Table 93-1 . Figure 93-1 Anatomic display of the stages of cervix cancer defined by location extent of tumor frequency of presentation and 5-year survival. Cervix Cancer Treatment Carcinoma in situ stage 0 can be managed successfully by cone biopsy or by abdominal hysterectomy. For stage I disease results appear equivalent for either radical hysterectomy or radiation therapy. Patients with disease stages II-IV are primarily managed with external beam irradiation and intracavitary treatment or combined modality therapy. Retroperitoneal lymphadenectomy has no proven therapeutic role. Pelvic exenterations have become increasingly rare due to improved radiation control. However they are sometimes performed for centrally recurrent or persistent disease. In women with locally advanced disease stages IIB-IVA .