Master Of Medicine

Carcinoma Cervix

The TNM staging system for cervical cancer is analogous to the FIGO stage.

• Stage 0 – full-thickness involvement of the epithelium without invasion into the stroma (carcinoma in situ)
• Stage I – limited to the cervix
  • IA – diagnosed only by microscopy; no visible lesions
    • IA1 – stromal invasion less than 3 mm in depth and 7 mm or less in horizontal spread
    • IA2 – stromal invasion between 3 and 5 mm with horizontal spread of 7 mm or less
  • IB – visible lesion or a microscopic lesion with more than 5 mm of depth or horizontal spread of more than 7 mm
    • IB1 – visible lesion 4 cm or less in greatest dimension
    • IB2 – visible lesion more than 4 cm
• Stage II – invades beyond cervix
  • IIA – without parametrial invasion, but involve upper 2/3 of vagina
  • IIB – with parametrial invasion
• Stage III – extends to pelvic wall or lower third of the vagina
  • IIIA – involves lower third of vagina
  • IIIB – extends to pelvic wall and/or causes hydronephrosis or non-functioning kidney

  Stage IV-Distant spread

• IVA – invades mucosa of bladder or rectum and/or extends beyond true pelvis
• IVB – distant metastasis

Key Points:4stages, each having two subdivisions A and B.No mention of LN status,Ascites.

Treatment

Tumour <5mm-Conization(to preserve fertility)or hysterectomy

Invasive lesions not extending to abdominal viscera or distal vagina-Hysterectomy+Chemotherapy+Radiotherapy

Recurrent disease- Radiotherapy.

Carcinoma Endometrium.

Stage I-Tumour limited to uterine corpus

• Stage IA: tumor limited to the endometrium
• Stage IB: invasion of less than half the myometrium
• Stage IC: invasion of more than half the myometrium

Stage II-Tumour confined to uterus and cervix

• Stage IIA: endocervical glandular involvement only
• Stage IIB: cervical stromal invasion

Stage III-Local spread confined to the pelvis

• Stage IIIA: tumor invades serosa or adnexa, or malignant peritoneal cytology
• Stage IIIB: vaginal metastasis
• Stage IIIC: metastasis to pelvic or para-aortic lymph nodes

Stage IV-Distant spread/organ invasion

• Stage IVA: invasion of the bladder or bowel
• Stage IVB: distant metastasis, including intraabdominal or inguinal lymph nodes

Key Points:4 stages Stage I and III has 3 subdivisions A,B,C.LN spread mentioned only in STAGE III AND IV

FIGO staging of Ca endometrium

• IA Tumor confined to the uterus, no or < ½ myometrial invasion
• IB Tumor confined to the uterus, > ½ myometrial invasion
• II Cervical stromal invasion, but not beyond uterus
• IIIA Tumor invades serosa or adnexa
• IIIB Vaginal and/or parametrial involvement
• IIIC1 Pelvic node involvement
• IIIC2 Para-aortic involvement
• IVA Tumor invasion bladder and/or bowel mucosa
• IVB Distant metastases including abdominal metastases and/or inguinal lymph nodes

Treatment

Stage I and II-TAH+BSO,stage II may also need adjuvant radiotherapy.

Stage III and IV-TAH+BSO+postoperative radiotherapy

Carcinoma Ovary

• Stage I – limited to one or both ovaries
  • IA – involves one ovary; capsule intact; no tumor on ovarian surface; no malignant cells in ascites or peritoneal washings
  • IB – involves both ovaries; capsule intact; no tumor on ovarian surface; negative washings
  • IC – tumor limited to ovaries with any of the following: capsule ruptured, tumor on ovarian surface, positive washings
• Stage II – pelvic extension or implants
  • IIA – extension or implants onto uterus or fallopian tube; negative washings
  • IIB – extension or implants onto other pelvic structures; negative washings
  • IIC – pelvic extension or implants with positive peritoneal washings
• Stage III – microscopic peritoneal implants outside of the pelvis; or limited to the pelvis with extension to the small bowel or omentum
  • IIIA – microscopic peritoneal metastases beyond pelvis
  • IIIB – macroscopic peritoneal metastases beyond pelvis less than 2 cm in size
  • IIIC – peritoneal metastases beyond pelvis > 2 cm or lymph node metastases
• Stage IV – distant metastases to the liver or outside the peritoneal cavity

Para-aortic lymph node metastases are considered regional lymph nodes (Stage IIIC).

Key Points:4 stages, First 3 stages have subdivisions A,B,C.IVth stage has no sudivisions.

The ovarian cancer stages are made up by combining the TNM categories in the following manner:

• Stage I: T1+N0+M0
  • IA: T1a+N0+M0
  • IB: T1b+N0+M0
  • IC: T1c+N0+M0
• Stage II: T2+N0+M0
  • IIa: T2a+N0+M0
  • IIB: T2b+N0+M0
  • IIC: T2c+N0+M0
• Stage III: T3+ N0+M0
  • IIIA: T3a+ N0+M0
  • IIIB: T3b+ N0+M0
  • IIIC: T3c+ N0+M0 or Any T+N1+M0
• Stage IV: Any T+ Any N+M1

Treatment

TAH+BSO+OMENTECTOMY

Postoperative chemotherapy

Neoadjuvant chemo

Radiotherapy

Immunotherapy.