Stage IA Squamous Cell Carcinoma Research Articles

Stage IA Squamous Cell Carcinoma of the Cervix: A Study of 365 Cases with Long-Term Follow-Up

Stage IA Squamous Cell Carcinoma of the Cervix: A Study of 365 Cases with Long-Term Follow-Up

Lung cancer detection with low-dose spiral computed tomography in chronic obstructive pulmonary disease patients

To determine whether low-dose spiral computed tomography (LDCT) can improve the lung cancer detection rate in chronic obstructive pulmonary disease (COPD) subjects. From October 1999 to December 2003, 374 COPD patients underwent LDCT for lung carcinoma screening. All subjects with an abnormal baseline CT scan were followed with serial CT scans as part of our protocol. Follow-up was continued until the demonstration of no change over a minimum of 24 months, or resolution. Sputum samples were also obtained for cytological analysis. On the baseline spiral CT scan, 132 of 374 patients (35.2%) had at least one non-calcified nodule that required periodic follow-up with CT scans. The median follow-up time was 21 months (range 2-48 months). Of the 374 COPD subjects, nine patients with primary lung cancer (2.4%) were detected: six were squamous cell carcinomas, two were small-cell lung carcinomas (SCLC), and one was adenosquamous carcinoma. Three of the nine tumors were in stage IA, two in stage IIB, two in stage IIIA, and two were limited SCLC. Potentially curative pulmonary resection was performed in four patients, pulmonary lobectomy in three, and wedge excision in one. One subject with stage IA squamous cell carcinoma received radiotherapy, as pulmonary function was severely impaired. In addition, four patients underwent removal of benign lesions. Sputum was collected in 205 (54.8%) of 374 patients. There were 154 (75 %) metaplasia, 14 (6%) moderate dysplasia, and one (0.4%) malignant case. LDCT increases early lung carcinoma detection rate in COPD patients, but pulmonary function impairment may reduce its benefit.

Challenging the concept of microinvasive carcinoma of the vulva: report of a case with regional lymph node recurrence and review of the literature

BackgroundIt is widely accepted that vulvar carcinoma with a depth of invasion of less than one millimeter is sufficiently treated by vulvectomy or wide local excision without inguinal lymphadenectomy.Case presentationHowever, a patient with inguinal lymph node recurrence 21 months after radical vulvectomy for stage IA squamous cell carcinoma was observed.ConclusionAccording to a review of the literature, there are five additional cases of metastasizing vulvar cancer with a depth of invasion of less than one millimeter. Therefore, the definition of microinvasive carcinoma of the vulva based on depth of invasion alone may not be as reliable as previously thought and does not rule out inguinal lymph node involvement or recurrence. Consequently, the necessity of inguinal node dissection for microinvasive carcinoma needs to be discussed on an individual basis taking into account the age of the patient as well as the potential morbidity of extended surgery.

Squamous Cell Lung Cancer Associated With an Anomaly of the Right Upper Lobe Bronchus

Background. Anomalous right upper and middle lobe bronchi originating from a common bronchus is a rare condition. We report a case of lung cancer associated with this anomaly. Case. A 67-year-old woman complained of productive cough and chest pain. A diagnosis of pneumonia was made in the right lung. Despite antibiotics, the shadow in the right lower lung field did not disappear. Therefore she underwent computed tomographic (CT) scan which revealed a mass in the right middle lobe. She was referred to our hospital on the suspicion of lung cancer. Bronchoscopy revealed right upper and middle lobe bronchi originating from a common bronchus. Squamous cell carcinoma was confirmed by curetting cytology of the right middle lobe bronchus. Bilobectomy of the right upper and middle lobes and lymphadenectomy was performed through a thoracotomy. After giving rise anteriorly to a large stem, the truncus superior (TS), the remaining stem of the right pulmonary artery, descended dorsally under the arch of the azygos vein. As the TS was thick, these two stems together presented a double-barreled appearance at surgery. The configuration of the dorsal stem after the branching off of the TS was similar to that seen in the left lung. No minor fissure between the upper and middle lobes was observed, and the posterior part of the major fissure was undeveloped. There was no abnormality in the pulmonary veins. The postoperative course of the patient was uneventful, and she was discharged on the fifth postoperative day. The pathologic diagnosis was stage IA squamous cell carcinoma. Conclusion. The bronchial anomaly was a mirror image of the left upper lobe bronchus. We were able to image the anatomic ramifications of the right pulmonary arteries by CT and 3D-CT scans. Pulmonary arteriography would have been optimal before surgery.

Stage Ia1 cervical squamous cell carcinoma: conservative management after laser conization with positive margins

Objective Cone margin status has been reported to be the most important predictor of recurrent disease in patients with cervical intraepithelial neoplasia (CIN) undergoing cervical conization. Our purpose was to evaluate the conservative management of selected patients with microinvasive (FIGO stage Ia1) squamous cell carcinoma who have been treated by cervical conization with positive margins. Methods Twenty-seven patients underwent KTP laser conization and vaporization for stage Ia1 squamous cell carcinoma followed by careful observation. Involved margins were diagnosed if CIN III or more was present at the ectocervical or endocervical margin and 7 patients formed the basis of the present study. Follow-up consisted of cytology, histology, and pelvic examination. Disease recurrence was defined as a histology diagnosis of CIN III or more on colposcopically directed biopsy or endocervical curettage. Results The endocervical margins were involved by carcinoma in situ in seven (26%) patients. No ectocervical margin involvement was detected. No lymph–vascular space involvement (LVSI) and confluent invasion were seen. All seven patients were free of recurrent disease during median follow-up of 4.0 (range 2.3–7.6) years. Conclusion These results suggest that laser conization and vaporization may be a reasonable treatment option in patients with microinvasive (FIGO Stage Ia1) squamous cell carcinoma despite positive cone margins without invasive disease when LVSI is not demonstrated.

Microinvasive squamous carcinoma of the cervix: treatment modalities.

Patients with FIGO stage IA1 squamous cell carcinoma of the cervix can be treated conservatively with simple hysterectomy or, if young and desiring to preserve their fertility, with conization only, provided surgical margins are free of dysplasia or invasive disease. When the surgical margins are involved a repeat conization should be performed. Patients with FIGO stage IA2 or stage IA1 carcinoma with extensive lymph vascular space invasion benefit from a modified radical hysterectomy with pelvic lymph node dissection. If preservation of fertility is an issue, then conization with extraperitoneal or laparoscopic pelvic lymphadenectomy can be performed. Alternatively, radical trachelectomy with pelvic lymphadenectomy may be a safer procedure. Individualization of therapy based on an exhaustive pathological evaluation of an adequate cone biopsy specimen is of paramount importance for treatment planning and disease control.

Microinvasive squamous carcinoma of the cervix: treatment modalities

Patients with FIGO stage IA1 squamous cell carcinoma of the cervix can be treated conservatively with simple hysterectomy or, if young and desiring to preserve their fertility, with conization only, provided surgical margins are free of dysplasia or invasive disease. When the surgical margins are involved a repeat conization should be performed. Patients with FIGO stage IA2 or stage IA1 carcinoma with extensive lymph vascular space invasion benefit from a modified radical hysterectomy with pelvic lymph node dissection. If preservation of fertility is an issue, then conization with extraperitoneal or laparoscopic pelvic lymphadenectomy can be performed. Alternatively, radical trachelectomy with pelvic lymphadenectomy may be a safer procedure. Individualization of therapy based on an exhaustive pathological evaluation of an adequate cone biopsy specimen is of paramount importance for treatment planning and disease control.

Early invasive carcinoma of the cervix (3 to 5 mm invasion): Risk factors and prognosis: A Gynecologic Oncology Group study

OBJECTIVE: Our purpose was to evaluate the risk factors and prognosis in patients with stage IA squamous cell carcinoma of the cervix and 3 to 5 mm of invasion. STUDY DESIGN: From 1981 to 1984 the Gynecologic Oncology Group conducted a prospective clinicopathologic study of patients with stage I carcinoma of the cervix. A selective study group that was previously defined and reported included patients with squamous cell carcinoma of the cervix who were treated with radical hysterectomy and pelvic lymphadenectomy and who had disease confined to the uterus, with or without microscopically positive lymph nodes. RESULTS: One hundred eighty-eight patients had invasion of 3, 4, or 5 mm as determined by central pathology review. Patients who satisfied the 3 to 5 mm invasion definition of the current stage IA 2 classification of the International Federation of Gynecology and Obstetrics (1995) are the subject of this report. CONCLUSIONS: Patients with stage IA 2 carcinoma of the cervix who have 3 to 5 mm of invasion present on conization with no invasion in the hysterectomy specimen are at very low risk for lymph node metastases, recurrences, or death caused by cancer. (Am J Obstet Gynecol 1998;178:62-5.)

Stage IA squamous cell carcinoma of the uterine cervix

The microscopic pathology and clinical courses of 44 patients treated with radical hysterectomy and pelvic lymphadenectomy for equivocal or early invasive squamous cell carcinoma of the cervix were reviewed according to the classification of Frick and his associates. The incidence of major therapy complications was 14 per cent and all patients survived 5 or more years after therapy. Review of the literature on Stage IA lesions showed a 1.9 per cent incidence of lymph node metastases (103 patients), a 0.4 per cent recurrence rate in 243 patients treated conservatively, and a 1.0 per cent incidence of recurrence or evidence of primary spread beyond the cervix in 621 patients receiving all forms of therapy. From reported results, it would appear that equivocally invasive lesions and those lesions invasive up to 3 mm. without involvement of cervical lymphatics can be managed safely with conservative therapy.