Staging is clinical and consists of a pelvic examination under anesthesia with cystoscopy and proctoscopy. Chest x-ray, IV pyelography, and abdominal CT are used to search for metastases. The staging system and its influence on prognosis are shown in Table 73-1. At presentation, 47% of pts are stage I, 28% are stage II, 21% are stage III, and 4% are stage IV.
Treatment: Cervical Cancer Carcinoma in situ is cured with cone biopsy. Stage I disease may be treated with radical hysterectomy or radiation therapy. Stages II-IV disease are usually treated with radiation therapy, often with both brachytherapy and teletherapy, or combined-modality therapy. Pelvic exenteration is used uncommonly to control the disease, especially in the setting of centrally recurrent or persistent disease. Women with locally advanced (stage IIB-IVA) disease usually receive concurrent chemotherapy and radiation therapy. The chemotherapy acts as a radiosensitizer. Hydroxyurea, 5-fluorouracil (5FU), and cisplatin have all shown promising results given concurrently with radiation therapy. Cisplatin, 75 mg/m2 IV over 4 h on day 1, and 5FU, 4 g given by 96-h infusion on days 1-5 of radiation therapy, is a common regimen. Relapse rates are reduced 30-50% by such therapy. Advanced-stage disease is treated palliatively with single agents (cisplatin, irinotecan, ifosfamide). Bevacizumab may improve the antitumor effects of chemotherapy. |
For a more detailed discussion, see Seiden MV: Gynecologic Malignancies, Chap. 117, p. 592, in HPIM-19. |
Section 6. Hematology and Oncology