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Staging for Cervical Cancer. Can be done under anaesthesia WHO recommends downstaging Aim is to obtain adequate Histological specimen for conformation ( 90% are SCC and 10 - 15% are adenocarcinoma) Stage IA Cancer confined to the cervix Stage IB
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Staging for Cervical Cancer • Can be done under anaesthesia • WHO recommends downstaging Aim is to obtain adequate Histological specimen for conformation (90% are SCC and 10 - 15% are adenocarcinoma) Stage IA Cancer confined to the cervix Stage IB Stage II A Cancer beyond cervix extending to upper 1/3 vagina Stage II B Cancer beyond the cervix extending to para-metrium
Stage III A - Cancer beyond the cervix extending distal portion of the vagina. • Stage III B - Cancer beyond the cervix extending to pelvic side wall. • Stage IV A/IV B - Cancer has spread to bladder/ rectum and can involve distant metastasis (in stage IV B)
N.B Stage IB1 - diameter cancer < 4cm Stage IB2 - diameter cancer > 4cm Most operable cervical cancers are stage II A and Below: Aim of surgery is to remove entire margins of tumour and any metastatic disease in the pelvis. • Extended Hysterectomy and bilateral pelvic lymphadenectomy (“Wetheims” “Meigs”).
Remove uterus with its parematrium, cervix and paracervical tissue, vaginal cuff, Right and Left pelvic lymph nodes. • Post-surgical radiotherapy must be offered to women with incomplete resection margins and those with metastatic pelvic nodes. • Stage 1B2 is best treated by initial radiation therapy before surgical intervention.
Complications • Anaesthetic • Haemorrhage • Damage urinary/bowel systems • Infection (UTI/Pelvic/Wound/Atelactosis) • Lymphoecele • DVT Preservation of ovaries Preservation of functional vagina Radiotherapy can be used to treat all stages of cervical cancer and is the only option available for the non-operable stage II B and above.