Cervical Cancer
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Cervical Cancer epidemiology, risk factors, staging and treatment
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Cervical Cancer
- 1. Invasive Cervical Cancer Pedro T. Ramirez, M.D. Associate Professor Director of Minimally Invasive Research & Education Department of Gynecologic Oncology
- 17. Surgical options for early stage cervical cancer Stage IA1 Stage IA2-IB1 (<2 cm) Fertility Preservation Stage IA2-IB1 and IIA Cervical conization (fertility-sparing) Abdominal Radical Trachelectomy and Lymphadenectomy Abdominal radical hysterectomy plus lymphadenectomy Simple hysterectomy Vaginal Radical Trachelectomy plus Laparoscopic Lymphadenectomy Radical Vaginal Hysterectomy plus laparoscopic or extraperitoneal lymphadenectomy Robotic Radical Trachelectomy plus Lymphadenectomy Laparoscopic assisted radical vaginal hysterectomy plus lymphadenectomy Total laparoscopic/robotic radical hysterectomy plus lymphadenectomy
- 20. Daniel Dargent Radical Vaginal Trachelectomy 1994
- 25. 435 Radical hysterectomy 186 pts <40 yrs 249 pts >40 yrs 174 pts Eligible Histology 12 pts Ineligible Histology 98 pts <2 cm tumor 76 pts >2 cm tumor 8 pts Ineligible by stage 89 (48%) pts <40yrs Eligible 1 pts Ineligible by infertility
- 32. Sedlis A, Bundy BN, Rotman MZ, et al. A randomized trial of pelvic radiation therapy versus no further therapy in selected patients with stage IB carcinoma of the cervix after radical hysterectomy and pelvic lymphadenectomy: a Gynecologic Oncology Study Group Study. Gynecologic Oncology 73:177, 177-83, (1999), Other Indications for postoperative XRT treatment (HIGH INTERMEDIATE RISK) LVSI Stromal Invasion Tumor Size Positive Deep 1/3 Any Positive Middle 1/3 > 2 cm Positive Superficial 1/3 > 5 cm Negative Deep or middle 1/3 > 4 cm
- 35. Incidence of Recurrence Fagundes, H. et al. Int J Radiat Oncol Biol Phys 1992; 24:197 Stage Local (Pelvic) Distant IA <1% 3% IB 10% 16% IIA 17% 31% IIB 23% 26% III 42% 39% IV 74% 75%
- 40. OPERATIVE TECHNIQUE Modified VRAM Flap Sood et al, Obstet Gynecol 2005 8 cm 1x6 cm skin graft Inferior epigastric artery Myocutaneous flap
- 43. MD Anderson Cancer Center
Notes de l'éditeur
- It is now accepted that infection with the human papillomavirus (HPV) is central to cervical carcinogenesis. Worldwide, the prevalence of HPV in cervical tumors is 99.7%.
- Additional epidemiologic risk factors for cervical cancer include early onset of sexual activity, multiple sexual partners, and a high-risk sexual partner, history of a sexually transmitted infection, smoking, immunosuppression, low socioeconomic status and previous history of vulvar, vaginal or cervical squamous dysplasia.
- Physical exam is crucial for determining extent of disease. FIGO guidelines allow palpation and inspection of the primary tumor, palpation of the groin and supraclavicular lymph nodes. Careful rectovaginal exam allows more thorough investigation of possible parametrial, cul-de-sac, or pelvic sidewall involvement. Exam under anesthesia can provide a more comfortable and thorough exam. Diagnostic exams such as radiographs of chest and skeleton, intravenous pylogram (IVP) studies may be utilized. Procedures such as conization, cystoscopy, and proctosigmoidoscopy are also acceptable diagnostic aids for staging.
- Critics to the FIGO staging state that important prognostic factors, such as lymph node involvement cannot be determined with allowable staging procedures.