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Case History

image A 38-year-old woman, para 2 + 0, presents with post-coital bleeding. Colposcopy shows a cervical lesion, which on biopsy is a mixed adeno-squamous carcinoma. Examination under anaesthesia suggests right parametrial involvement. Radiological staging confirms this and suggests the presence of a single, enlarged left iliac lymph node but no disease elsewhere and no hydronephrosis.

What is the stage of this tumour?

What is the standard treatment? Discuss the evidence to support the use of chemotherapy in this scenario.

Discuss the factors that most strongly predict the prognosis in this patient. What implications does that have for management?


What is the stage of this tumour?

image The stage is IIB. The International Federation of Gynecology and Obstetrics (FIGO) staging (Table 42.1) of cervical cancer is based on clinical evaluation, which, preferably, should be carried out by an experienced examiner and under anaesthesia. When it is uncertain which the stage a particular case should be allocated, the earlier stage is mandatory. Staging may involve palpation, inspection, colposcopy, endocervical curettage, hysteroscopy, cystoscopy, proctoscopy, intravenous urography and radiographic examination of the lungs and skeleton. Confirm involvement of the bladder or rectum with a biopsy.

Table 42.1Staging guidelines from the International Federation of Gynecology and Obstetrics (FIGO)

There are some drawbacks of the FIGO classification. Lymph node involvement is one of the most important negative prognostic factors in cervical cancer, other than metastasis, but this is not included in the current FIGO staging classification. In addition, staging does not depend on the contemporary radiological imaging techniques (e.g. computed tomography [CT], magnetic resonance imaging and positron emission tomography) that are commonly used in developed countries. If surgery is done, it may reveal that the cancer is more advanced than initially thought. Although this new information may alter the treatment plan, it does not change the patient's FIGO stage. The American Joint Committee on Cancer's TNM nomenclature should be used for this purpose.


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