Cancers Metastatic to Cervix by Direct Extension

Rectal

Intra-abdominal

Bladder

Endometrial

Occasionally (via hematogenous spread): Breast, lung

SITES OF DISTANT ORGAN METASTASES (IN ORDER OF FREQUENCY)

1. Lung

2. Liver

3. Bone

CLINICAL STAGING OF INVASIVE CERVICAL CANCER

Clinical staging of cervical cancer is important for prognosis and treatment. Modes of Staging

■ Pelvic and rectal exam (under anesthesia)

■ Liver function tests

■ Evaluate genitourinary tract via intravenous pyelogram or computed tomography (CT) with intravenous contrast dye.

■ Evaluate lymph node enlargements or abnormalities with external CT-guided biopsies.

TREATMENT OF INVASIVE CERVICAL CANCER

Radical surgery—radical hysterectomy with lymph node dissection Radiation therapy—high-dose delivery to the cervix and vagina, and minimal dosing to the bladder and rectum:

■ External beam whole pelvic radiation

■ Transvaginal intracavitary cesium—transvaginal applicators allow significantly larger doses of radiation to surface of cervix.

TREATMENT FOR BULKY CENTRAL PELVIC DISEASE

Hysterectomy after radiation therapy Tumor cytoreduction:

■ Use of cytotoxic chemotherapy before definitive treatment with radiation or radical surgery

RECURRENT CERVICAL CARCINOMA

Radical hysterectomy requires removal of: Uterus Cervix

Parametrial tissue Upper vagina

+ Pelvic lymphadenectomy from the bifurcation of the iliac vessels to the level of the inguinal ligament

Recurs within 2 to 3 years of primary treatment

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