Obstetrics & Gynecology>>>>>Benign and Malignant Disorders of the Breast and Pelvis
Question 4#

A 51-year-old woman is diagnosed with invasive cervical carcinoma by cone biopsy. Pelvic examination and rectal-vaginal examination reveal the parametrium to be free of disease, but the upper portion of the vagina is involved with tumor. Intravenous pyelography (IVP) and sigmoidoscopy are negative, but a computed tomography (CT) scan of the abdomen and pelvis shows grossly enlarged pelvic and periaortic nodes.

This patient is classified at which of the following stages?

a. IIa
b. IIb
c. IIIa
d. IIIb
e. IV

Correct Answer is A

Comment:

Cervical cancer is still staged clinically, not surgically. Physical examination, routine x-rays, barium enema, colposcopy, cystoscopy, proctosigmoidoscopy, and IVP are used to stage the disease. CT scan results, while clinically useful, are not used to stage the disease. The stage does not include information about lymph node involvement. Stage I disease is limited to the cervix. Stage Ia disease is preclinical (ie, microscopic), while stage Ib denotes macroscopic disease that is clinical visible. Stage II invades beyond the uterus but not to the pelvic side wall or lower third of the vagina. It may involve the upper vagina and/or the parametrium. Stage IIa denotes tumor without parametrial invasion or involvement of the lower third of the vagina, while stage IIb denotes parametrial extension. Stage III involves the lower one-third of the vagina or extends to the pelvic side wall; there is no cancer-free area between the tumor and the pelvic wall. Stage IIIa lesions have not extended to the pelvic wall, but involve the lower one-third of the vagina. Stage IIIb tumors have extension to the pelvic wall and/or are associated with hydronephrosis or a nonfunctioning kidney caused by tumor. Stage IV is outside the reproductive tract, such as invasion of the mucosa of the bladder or rectum.