Staging - Cervical Cancer

Question 1

What staging is used for gynae cancers?

Answer 1

FIGO (The International Federation of Gynaecology and Obstetrics 1974) - unusual to see TNM staging

Question 2

Stage 1 description

Answer 2

The carcinoma is strictly confined to the cervix uteri (extension to the corpus should be disregarded)

Question 3

Stage 1 - IA description

Answer 3

Invasive carcinoma that can be diagnosed only by microscopy, with a maximum depth of invasion <5mm

Question 4

Stage 1 - IA1 description

Answer 4

Measured stromal invasion <3mm in depth

Question 5

Stage 1 - IA2 description

Answer 5

Measured stromal invasion >3mm (inclusive) and <5mm in depth

Question 6

Stage 1 - IB description

Answer 6

Invasive carcinoma with measured deepest invasion >5mm (inclusive) - greater than stage IA, lesion limited to the cervix uterine

Question 7

Stage 1 - IB1 description

Answer 7

Invasive carcinoma >5mm (inclusive) depth of stromal invasion and <2cm in greatest dimension

Question 8

Stage 1 - IB2 description

Answer 8

Invasive carcinoma >2cm (inclusive) depth of stromal invasion and <4cm in greatest dimension

Question 9

Stage 1 - IB3 description

Answer 9

Invasive carcinoma >4cm (inclusive) in greatest dimension

Question 10

Stage 2 description

Answer 10

The carcinoma invades beyond the uterus, but has not extended into the lower third of the vagina or pelvic wall

Question 11

Stage 2 - IIA description

Answer 11

Involvement limited to the upper two-thirds of the vagina without parametrial involvement

Question 12

Stage 2 - IIA1 description

Answer 12

Invasive carcinoma <4cm in greatest dimension

Question 13

Stage 2 - IIA2 description

Answer 13

Invasive carcinoma >4cm (inclusive) in greatest dimension

Question 14

Stage 2 - IIB

Answer 14

With parametrial involvement but not up to the pelvic wall

Question 15

Stage 3 description

Answer 15

The carcinoma involves the lower third of the vagina and/or extends into he pelvic wall and/or causes hydronephrosis or non-functioning kidney and/or involves pelvic and/or paraaortic lymph nodes

Question 16

Stage 3 - IIIA description

Answer 16

Carcinoma involves the lower third of the vagina, with no extension into the pelvic wall

Question 17

Stage 3 - IIIB description

Answer 17

Extension into the pelvic wall and/or the hydronephrosis or non-functioning kidney (unless known to be due to another cause)

Question 18

Stage 3 - IIIC description

Answer 18

Involvement of pelvic and/or paraaortic lymph nodes, irrespective of tumour size and extent

Question 19

Stage 3 - IIIC1 description

Answer 19

Pelvic lymph node metasteses only

Question 20

Stage 3 - IIIC2 description

Answer 20

Paraaortic lymph mestasteses

Question 21

Stage 4 description

Answer 21

The carcinoma has extended beyond the true pelvis and has involved (biopsy proven) the mucosa of the bladder or rectum. A bulls edema does not permit a case to be allotted to the stage 4

Question 22

Stage 4 - IVA description

Answer 22

Spread of growth to adjacent organs

Question 23

Stage 4 - IVB description

Answer 23

Spread of growth to distant organs

Question 24

As disease advances, it spreads in 3 main directions, what are these?

Answer 24

Adjacent stuctures
Along epithelial cells of the uterus
Through interstitial spaces of parametric tissue

Question 25

Cervical spread superiorly

Answer 25

Spread into the uterine body

Question 26

Cervical spread inferiorly

Answer 26

Into the vaginal vault

Question 27

Cervical spread laterally

Answer 27

Into the parametria and on to the lateral walls of the true pelvis

Question 28

Cervical spread anteriorly

Answer 28

To base of the bladder

Question 29

Cervical spread posteriorly

Answer 29

To rectum

Question 30

What can local disease progression result in?

Answer 30

Compression of ureters

Question 31

What is the percentage of lymphatic spread in stage IB (tumour confined to the cervix)?

Answer 31

20%

Question 32

What is the percentage of lymphatic spread in stage III (tumour extends to the lower 1/3rd of vagina and/or pelvis sidewalls)

Answer 32

60%

Question 33

What are the 2 main groups of lymph nodes in the female pelvis?

Answer 33

Internal iliac nodes Perivesical lymph nodes

Question 34

What are the 3 nodes within the internal iliac nodes?

Answer 34

Superior gluteal Inferior gluteal Sacral

Question 35

What are the 3 nodes with the perivesical lymph nodes?

Answer 35

Pre vesicular Post vesicular Lateral vesicular

Question 36

What are the other 3 nodes in the pelvis?

Answer 36

Parauterine Paravaginal Anorectal (pararectal)

Question 37

Where and in what order does lymphatic invasion spread to?

Answer 37

Paracervical Parametrial Obturator Internal, external and common iliac nodes Lateral sacral nodes Para-aortic nodes

Question 38

Worst prognostic factors

Answer 38

Tumour bulk <4cm Presence of lymph node spread Poorly differentiated tumours Parametrial involvement Other co-morbidites