Disease Recurrence

■ Most DES-related clear cell carcinomas recur < 3 years of initial treatment.

■ Pulmonary and supraclavicular nodal metastasis common ^ yearly screening chest x-ray recommended

TABLE 21-1. Staging of Invasive Cervical Cancer

International Federation of Gynecologists and

Obstetricians (FIGO) Stage Description of Carcinoma

5-Year Survival Rate Post Treatment

In situ; intraepithelial carcinoma

Confined to cervix; preclinical IA Preclinical

(Diagnosis only by microscopy) ■ Minimal microscopic invasion of stroma: ■ Max of 7-mm horizontal spread

IA-2 > 3-mm to < 5-mm depth from the base of the epithelium

IB ■ Clinically confined to cervix ■ Preclinical greater than IA-2

IB-1 Clinical lesion < 4 cm in diameter

IB-2 Lesion > 4 cm in diameter

Carcinoma extends beyond cervix

Has not extended to pelvic wall

Involves upper two thirds of vagina, but not lower 2

IIA No parametrial involvement

IIB Obvious parametrial involvement

IIIA Does not involve pelvic wall

IIIB Involves pelvic wall

Carcinoma extends beyond true pelvis

30-40% if adenocarcinoma

IIB Obvious parametrial involvement

III

m

Carcinoma extended to pelvic wall

< 60%

m

No cancer-free space between the tumor and the pelvic

20-30% if

wall (on rectal exam)

adenocarcinoma

m

Tumor involves lower one third of vagina

m

Hydronephrosis or nonfunctioning kidney

IIIA Does not involve pelvic wall

Clinically involves mucosa of bladder or rectum

IVA Spread to adjacent organs

IVB Spread to distant organs

TABLE 21-2. TNM Category Staging

First Resection of Primary Tumor

TABLE 21-2. TNM Category Staging

TX

Primary tumor cannot be assessed

T0

No evidence of primary tumor

T1

Confined to cervix

Upper two thirds vagina but not lower one third

T2a

No parametrium

T2b

Parametrial involvement

T3

Tumor extends to pelvic wall Involves lower one third vagina Kidney dysfunction

T3a

Pelvic wall not involved

T3b

Pelvic wall involved

T4

Distant metastasis

T4a

Adjacent organs

T4b

Distant organs

N

Regional Lymph Nodes

NX

Regional lymph nodes cannot be assessed

N0

No regional lymph node metastasis

N1

Regional lymph node metastasis

M

Distant Metastasis

MX

Presence of distant metastasis cannot be assessed

M0

No distant metastasis

M1

Distant metastasis (excludes peritoneal metastasis)

TABLE 21-3. Grading of Cervical Carcinoma

Grade

Invasive Squamous Tumor Adenocarcinoma

X

Cannot be assessed

1

Well differentiated ■ Small component of solid growth and nuclear atypia ■ Mild to moderate

2

Moderately differentiated Intermediate-grade differentiation

3

Poorly differentiated ■ Solid pattern

■ Severe nuclear atypia predominate

4

Undifferentiated

NOTES

NOTES

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