Stage IB Cervical Carcinoma Research Articles

Prognostic significance of parametrial extension in patients with cervical carcinoma Stages IB, IIA, and IIB. A study of 628 cases treated by radical hysterectomy and lymphadenectomy with or without postoperative irradiation.

Parametrial extension was evaluated as a prognostic factor in 628 patients with cervical carcinoma treated by radical hysterectomy and pelvic lymphadenectomy at the Aichi Cancer Center in Nagoya, Japan. Clinical examination without anesthesia staged 362 cases as IB, 43 as IIA, and 223 as IIB. Parametrial extension was found in 25 (7%) with Stage IB, 10 (23%) with IIA, and 76 (34%) with IIB. Nodal metastasis was shown in 47 (13%) with Stage IB, 10 (23%) with IIA, and 86 (39%) with IIB. When cancer extended into the parametrial tissues, nodal (N) metastasis rates were significantly increased from 12% to 32% for Stage IB (P less than 0.005), from 9% to 70% for IIA (P less than 0.001), and from 29% to 58% for IIB (P less than 0.001). Incidence of patients with one to three positive nodes decreased, and that of those with four or more positive nodes increased with parametrial extension (P less than 0.01). Corrected 5-year survival rates of patients were 94% for Stage IB, 95% for IIA, and 78% for IIB. Although there were differences between survivals of patients with Stage IB [N(-)] and IIB N(-) (P less than 0.05), as well as between those with IB [N(+)] and IIB N(+) (0.05 less than P less than 0.1), these differences disappeared when the cases were subdivided by parametrial extension. These results indicate that parametrial extension is a very important factor in nodal metastasis, number of positive nodes, and patient survival.

The significance of microscopic involvement of the parametrium and/or pelvic lymph nodes in cervical cancer stages IB and IIA

From 1961 through 1980, 388 patients with cervical carcinoma stage IB (272) and stage IIA (116) were treated by radical hysterectomy and pelvic lymphadenectomy. The operation specimens were divided into four groups: no involvement of the parametrium and pelvic lymph nodes (71.4%), involvement of the parametrium alone (7.2%), involvement of the pelvic lymph nodes alone (11.9%), and involvement of both the parametrium and pelvic lymph nodes (9.5%). Two hundred thirty-eight patients were followed for at least 5 years. The corrected 5-year survival figures for these four groups (stages IB and IIA together) were 90.3, 75.0, 62.1, and 50.0%, respectively. The differences are of statistical significance ( P < 0.005). Not only the stage of disease and involvement of the lymph nodes, but clearly also the involvement of the parametrium is of significance for the results of treatment in cervical cancer.

Stage IB cervical carcinoma and pregnancy: Report of 49 cases

In a study of 49 cases of Stage IB cervical carcinoma associated with pregnancy, the 5-year survival rate was 69.8%, the incidence of tumor-positive pelvic lymph nodes was 25.0%, and the posttreatment serious complication rate was 22.4%. These were significantly different from parameters generated in our center's overall experience with Stage IB cervical carcinoma (p < 0.001, p < 0.05, and p < 0.001). When associated with pregnancy, the 28.8% serious complication rate in patients receiving radiotherapy was significantly higher (p < 0.025) than the 6.7% rate observed in patients undergoing radical hysterectomy and lymph node dissection. No effect on 5-year survival was observed regarding time of gestation when diagnosis was made, method of delivery, or treatment modality. A subgroup of patients with diagnoses made in the second or third trimester all underwent cesarean section and appeared to have improved survival when radical hysterectomy and lymph node dissection accompanied this procedure as compared to those patients having postpartum radiotherapy.

Ovarian function after radical hysterectomy for Stage IB carcinoma of cervix

Ovarian function was assessed in 20 patients after radical hysterectomy and lymph node dissection for Stage IB cervical carcinoma. All patients were under 45 years of age, and four were or had been on estrogen therapy for postmenopausal symptoms. The other 16 patients were free of symptoms and demonstrated premenopausal gonadotropin profiles. Fourteen of these 16 had luteal phase serum progesterone levels. Only one patient required reoperation for a pathologic condition of the adnexa. A surgical approach to Stage IB cervical carcinoma conserves ovarian function in 80% of patients.

Primary surgical treatment in one hundred ninety-five cases of Stage IB carcinoma of the cervix

Stage IB carcinoma of the cervix may be treated primarily by either radiotherapy or operation. A primary surgical approach was used in 95 patients for the following indications: young age with desire to retain ovarian function (124), pelvic inflammatory disease (33), pregnant or post partum (15), refusal of radiotherapy (11), anatomic problems contraindicating radiotherapy (10), undiagnosed pelvic mass (seven), verrucous tumor (three), mucus-secreting tumor (two), syphilis (one), and previous radiotherapy for Hodgkin's disease (one). Twelve patients had two indications. The surgical procedures were radical abdominal hysterectomy and pelvic lymph node dissection (191) and Schauta-Amreich (radical vaginal) hysterectomy (4). Fourteen patients had serious postoperative complications. The uncorrected 5-year survival rate (95.1% follow-up) was 91.1%. The rationale for recommending a primary surgical approach to selected patients with Stage IB cervical carcinoma is presented.

Selective postoperative radiotherapy in stage ib cervical carcinoma following radical hysterectomy and pelvic lymphaoenectomy

Eighty-two patients with Stage IB squamous cell carcinoma of the cervix treated by radical hysterectomy and bilateral pelvic lymphadenectomy were analyzed for histopathologic prognostic factors including depth of cervical stromal invasion, degree of differentiation of the tumor and lymph node involvement. The influence of these factors on the outcome was studied. A correlation was found in that advanced depth (outer one-third) of cervical stromal invasion appeared to increase the risk of nodal involvement (44% vs 7%:P<O.O5) and subsequent recurrence in patients with negative nodes (36% vs 4%:P<O.O5). Grade-3 disease was more often present in patients with outer one-third cervical stromal invasion. A subgroup of patients is described, who are at high risk for recurrent disease following surgery and who may benefit from adjuvant postoperative radiotherapy.

Histologic classification, lymph node metastases, and patient survival in stage IB cervical carcinoma: An analysis of 245 uniformly treated cases

The role which histologic grading plays in the prognosis of cervical carcinoma is controversial. The basis for subdividing these lesions into small cell carcinomas and keratin- or nonkeratin-producing large cell carcinomas has usually been the assumption, though never statistically supported, that the small cell carcinomas are more aggressive. We tested this hypothesis by studying 245 FIGO Stage IB cases uniformly treated between 1970 and 1973. To evaluate prognosis, we selected two parameters: lymph node metastases and crude 2-year survival rate. Our data show that there is no statistically significant difference in either of these parameters to suggest that these malignancies behave differently in respect to keratinization or cellular size. Preliminary results suggest that patients in whom the cancer and cervical stroma have a characteristically well-demarcated interface may have improved short-term survival rates.

Isolated Para-Aortic Lymph Nodes Recurrence in Carcinoma Cervix

Background: To evaluate the presentation of isolated para-aortic lymph node recurrence after definitive treatment, and to analyze the effect of salvage treatment on the survival rate. Methods: A retrospective study was done for patients with invasive carcinoma of the uterine cervix treated with various modalities of treatment at Shaukat Khanum Memorial Cancer Hospital Research Center Lahore Pakistan from December, 1999 to August 2004. Results: The incidence of radiographically detected para aortic lymph node recurrence was 3.7% by FIGO stage at original diagnosis was 3 (50 %) in stage IIIB, 2 (33.3%) in post hysterectomy status and 1 (16.7%) in stage IB cervical carcinoma. Total 4 (66.7%) patients with para-aortic lymph nodes recurrences were identified with in the first 12 months after the initial treatment and 2(33.3%) had their recurrence after 12 month. Leg swelling, low back pain and hydronephrosis were observed when inquired for the presentation in those patients with recurrence in paraarotic lymph nodes. Hydronephrosis was the commonest finding (50%) either alone or in association with other symptoms. And 3 (50%) of the patient were died within two year of the diagnosis of recurrence.Three patients are still on follow up, one with progressive disease in liver and one with chronic renal failure, and one asymptomatic. Patient who received radiation alone had overall survival of 3.16 months after the recurrence compared with &gt;12 months overall survival for those treated with chemotherapy. Conclusions: Symptoms like leg swelling, low back pain and hydronephrosis helps a lot to detect the early paraaortic recurrence, hydronephrosis being commonest. Although the number of patients with para-aortic recurrence were very small and the follow up time was too short to make any recommendations for salvage treatment or survival advantages, as a definitive treatment for isolated para aortic lymph nodes we can offer both radiotherapy or chemotherapy. Key words: cervix; carcinoma; lymph nodes; para-aortic; recurrence. DOI: 10.3126/jnhrc.v7i2.3016 Journal of Nepal Health Research Council Vol.7(2) Apr 2009 103-107

A familial tubular absorption defect of glucose and amino acids.

<h3>Background:</h3> In the surgical treatment for early-stage cervical carcinoma, it is important to identify preoperatively a low-risk group of patients as candidates for less radical surgery to avoid the morbidity associated with radical hysterectomy. The aim of this study was to evaluate the correlation between tumor diameter measured preoperatively using magnetic resonance imaging (MRI) and pathological prognostic factors in International Federation of Gynecology and Obstetrics (FIGO) stage IB1 cervical carcinoma. <h3>Methods:</h3> A total of 125 patients with FIGO stage IB1 cervical cancer were included in this study. Clinical records, pathology reports, and MRI findings were retrospectively reviewed. <h3>Results:</h3> Histological diagnosis was squamous cell carcinoma in 57 patients and nonsquamous cell carcinoma in 68 patients. All patients underwent preoperative evaluation by MRI within a median period of 13.5 days before surgery. The tumor diameter measured by MRI ranged from zero (no tumor detected) to 42 mm, with a median of 23 mm. Pathological prognostic factors included parametrial involvement, lymph node metastasis, deep stromal invasion, and lymphovascular space invasion. All these factors were found less frequently in patients with a smaller tumor diameter. Most notably, parametrial involvement was seen in none of the patients with tumors 20 mm or less and was detected only in patients with tumors greater than 20 mm (<i>P</i> = 0.01). <h3>Conclusions:</h3> In the FIGO stage IB1 cervical carcinoma, the tumor diameter measured preoperatively by MRI correlates well with other pathological prognostic factors, especially with parametrial involvement. This finding suggests that the tumor diameter measured in preoperative MRI may serve as a strong predictor of parametrial involvement in FIGO stage IB1 cervical carcinoma, which can be used to select a candidate population for less radical surgery without the need for a cone biopsy before hysterectomy.