This Community is Archived.

This community is no longer active as of December 2018. Thanks to those who posted here and made this information available to others visiting the site.

Diagnosis and treatment of cervical cancer

By Maggie Sullivan | 04 Aug, 2011

Hello. I'm an NP volunteering in Guatemala on a cervical cancer project. We have a patient with a cervical biopsy path report that reads as follows, and roughly translated:
 
Microscopic exam of cervical bx
infiltrative neoplasia, comprised of large cells with eosinofilic cytoplasm and irregular nuclei. Abundant atypical nuclei and mytosis. The neoplasm infiltrates without glandular formation nor keratinization. There are necrotic zones.
Diagnosis
Infiltrative epidermoid carcinoma, of large cells, without keratinization


Exam Microscopico
"Se observa neoplasia infiltrante constituida por cellulas grandes con citoplasma eosinofilo y nucleo irregular. Hay abundantes atipias nucleares y mitosis. La neoplasia infiltra en mantos sin formaciones glandulares ni queratinizacion. Hay zonas de necrosis."
Diagnostico
"Carcinoma epidermoide infiltrante, de cellulas grandes, no queratinizante"

My question is, can treatment recommendations be based on this cervical bx path report alone, or are additional procedures required? If the recommendation would be for a hysterectomy, we can easily arrange for this. If additional procedures/chemo/radiation are recommended, this would be much more complicated, but hopefully doable. This is a 50 year-old woman G10 P10.

Any opinions/suggestions would be much appreciated!
Thanks,
Maggie

Replies

 

Annekathryn Goodman Replied at 8:24 AM, 5 Aug 2011

Hi Maggie,
There are a few important things that need to be done before considering a hysterectomy for this patient:
what is her pelvic exam like?
are there imaging capabilities in Guatemala?

The indications for hysterectomy as treatment of cervical cancer: A cervical cancer that is confined to the cervix. That would be a stage I cancer.
In North America and Europe, cancers that measure more than 4 cm are usually treated with chemotherapy plus radiation. But in a resource poor region, a radical hysterectomy is another option.

It is very important that a real radical hysterectomy is performed and not a simple hysterectomy.

wikipedia has a pretty nice description:

http://en.wikipedia.org/wiki/Hysterectomy

So pelvic exam is crucial, if you see a visible lesion that is confined to the cervical and is less than 4 cm, surgery is ideal. If you see something bigger or the vagina or parametria is involved, it is better to do radiation (and as I said, current standard of care is radiation with chemo but if you do not have chemo capabilities radiation alone)

The second important piece to evaluation is looking for spread. A chest xray and IVP are the traditional standards. If there is CT scan capability that is best.
I understand that those resources may not be available.
good luck

Annekathryn Goodman
Gynecologic Oncology
Massachusetts General Hospital
Boston

Gloria Halverson Replied at 11:47 AM, 5 Aug 2011

It would also be extremely helpful if pelvic lymph nodes could be sampled at the
time of the radical hysterectomy to look for spread and know if she needs
further treatment. Looking under the microscope may change your staging since it
is hard to do that with the naked eye and a pelvic exam alone. Gloria Halverson
M.D. Medical College of Wisconsin.

Maggie Sullivan Replied at 10:55 PM, 5 Aug 2011

Thank you both so much for your swift replies! I will see what our imaging options are here. CXR available for sure. I can look into IVP or CT. And before the patient goes anywhere, I can repeat her pelvic exam myself to clarify.
Again, this is very helpful for me to know as it's not always made clear to us by the healthcare system down here.
Thank you!
-Maggie

This Community is Archived.

This community is no longer active as of December 2018. Thanks to those who posted here and made this information available to others visiting the site.