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INTRODUCTION

Epidemiology

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Epidemiology
Incidence: 13,800 (Estimated new cases for 2020 in the United States) Stage at Presentation
    Localized: 44%
  7.3 per 100,000 women per year Regional: 36%
Deaths: Estimated 4290 in 2020 Distant: 15%
Median age: 50 years Unstaged: 4%

Siegel R et al. CA Cancer J Clin 2020;70:7-30

Surveillance, Epidemiology and End Results (SEER) Program, available from http://seer.cancer.gov [accessed June 2020]

Work-up

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Work-up
Stage IA/stage IB1:

  • H&P

  • CBC with platelet count, LFTs, BUN, creatinine

  • Cervical biopsy (pathologic review)

  • Cone biopsy as indicated

  • Chest x-ray, intravenous pyelogram, for IB1 MRI ± PET

Stage IB2 or greater:

  • Consider examination under anesthesia

Stages III/IV:

  • Consider cystoscopy/proctoscopy

Pathology

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Pathology

Squamous cell carcinomas

  • Large cell, keratinizing

  • Large cell, nonkeratinizing

  • Small cell (not neuroendocrine)

  • Verrucous carcinoma

75–80%

Adenocarcinomas

HPV associated

Usual endocervical (villoglandular and micropapillary variants)

Mucinous

Intestinal

Signet ring

Adenosquamous (Invasive stratified mucin-producing carcinoma variant)

 

Non-HPV associated

Gastric

Clear cell

Endometrioid

Mesonephric

23%

Glassy cell carcinoma Rare
Neuroendocrine small cell carcinoma Rare

NonHPV Associated adenocarcinomas more often have lymphovascular invasion and lymph node metastases, and are associated with worse survival

 

Hunter RD in: Souhami RL et al editors. Oxford Textbook of Oncology, 2nd ed., New York, Oxford University Press 2002:1835-1837

 

Stolnicu S, et al. Virchows Archiv 2019; 475:537-49.

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Pathology

Histologic Grade

Gx Cannot be assessed
G1 Well differentiated
G2 Moderately differentiated
G3 Poorly differentiated
G4 Undifferentiated

Staging

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Staging
FIGO Stage (2018)
I Cervical carcinoma is strictly confined to uterus (extension to corpus should be disregarded)
IA Invasive carcinoma diagnosed only by microscopy, with maximum depth of invasion <5 mm
IA1 Measured stromal invasion <3 mm in depth
IA2 Measured stromal invasion ≥3 mm and <5 mm in depth
IB Invasive carcinoma with measured deepest invasion ≥5 mm (greater than stage IA), lesion limited to the cervix uteri
IB1 Invasive carcinoma ≥5 mm depth of stromal invasion and <2 cm in greatest dimension
IB2 Invasive carcinoma ≥2 cm and <4 cm in greatest dimension
IB3 Invasive carcinoma ≥4 cm in greatest dimension
II The carcinoma invades beyond the uterus, but has not extended onto the lower third of the vagina or to the pelvic wall
IIA Involvement limited to the upper two-thirds of the vagina without parametrial involvement
IIA1 Invasive carcinoma <4 cm in greatest dimension
IIA2 Invasive carcinoma ≥4 cm in greatest dimension
IIB With parametrial involvement but not up to the pelvic wall
III The carcinoma involves the lower third of the vagina and/or extends to the pelvic wall and/or causes hydronephrosis or non-functioning kidney and/or involves pelvic and/or paraaortic lymph nodes
IIIA Carcinoma involves the lower third of the ...

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