Chirurgie du cancer

Abstrait

Staging Issues in Cervical Cancer

Chhabra S, Devi S, Chopra S and Singh A

Background: Worldwide cervical cancer is third most common cancer, but diagnostic, therapeutic problems continue in developing countries where it is most common cancer in women. Very few women report at operable stage. For those subjected to surgery, intraoperative findings, histopathology provides information for continuing or abandoning surgery, adjuvant therapy after surgery and so on. However clinical investigative staging may not be correct, leading to avoidable morbidity of surgery.

Objective: Study was done to know relationship between clinical, intraoperative, postoperative staging in women who underwent surgery for cervical cancer.

Material methods: Analysis duration was divided into 4 yearly 7 blocks. During study period 266 women underwent abdominal radical hysterectomy, 15 were for endometrial cancer so, 251 (94.36% radical hysterectomies for cervical cancer, 13.05% of all cervical cancers cases (stage I A, I B1, II A1) were study subjects.

Results: Cervical cancer cases increased over the years and also operable cases of cervical cancer from 13.33% to 30.00%. However of 251cases taken for surgery, 28% would not have been for surgery if were known to be of stage which was found intraoperative (preoperative under staging), over staging was only in 2%. Correlating clinical, histopathological staging 36% would not have been for surgery if correct staging (after histopathology) was known pre-operatively. Clinical intraoperative staging had 72% agreement. Histopathological staging which helps in planning treatment agreed with clinical staging in 64%. Problem of under staging continued over years.

Conclusion: With present day techniques available to women with low resources, there is a lot of under staging of cervical cancer cases which leads to unnecessary surgery. Low cost modalities for better evaluation of cases preoperatively and will help in reducing morbidity, save resources also.