Clinical signs and symptoms of cancer of the cervix

The important aspects of the diagnosis of cancer of the cervix are:

i) Abnormal uterine bleeding and vaginal discharge

ii)Presence of a cervical lesion on inspection as a tumour or ulceration.

iii)Vaginal cytology is usually positive. However it must be confirmed by biopsy.

The most common symptoms are metrorrhagia and postcoital bleeding (postcoital spotting). An important sign is the presence of cervical ulceration.

After invasion, bloody or purulent odorous, nonpruritic (Not itching) discharge may appear.

Late symptoms include bladder and rectal dysfunction, pain and or fistulas.

Staging of Cancer of the Cervix:

It is important to stage cancer of the cervix (Usually done under anaesthesia). Abdominal and pelvic CT scanning or MRI may also be very useful in staging

FIGO staging of cancer of the cervix

Preinvasive carcinoma

STAGE 0   :  Carcinoma in situ.

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Invasive carcinoma

STAGE I :  Carcinoma is strictly confined to the cervix.

1A  :  In stage 1A invasive cancer can be diagnosed only on microscopy. It must be noted that all gross lesions, including superficial invasion ,are stage 1B.

1A1 Measured invasion of stroma no greater than 3mm in depth and no wider than 7mm.

1A2 Measured invasion of stroma greater than 3mm in depth and no greater than 5mm in depth and no wider than 7mm

1B Clinical lesion confined to the cervix or pre-clinical lesions greater than 1A.

1B1 Clinical lesion no greater than 4 cm.

1B2 Clinical lesions greater than 4 cm

STAGE II: Carcinoma extends beyond the cervix but has not extended to the pelvic wall.The carcinoma involves the vagina but not as far as the lower third.

IIA : No obvious parametrial involvement

IIB : Obvious parametrial involvement

STAGE III: Carcinoma has extended either to the lower third of the vagina or to the pelvic side wall. This also includes all cases of hydronephrosis.

IIIA: Involvement of the lower third of the vagina. No extension to the pelvic side wall

IIIB: Extension to the pelvic wall and /or hydronephrosis or nonfunctioning kidney.

STAGE IV: Carcinoma extends beyond the true pelvis or clinically involving the mucosa of the bladder or rectum.

IVA: Spread of growth to the adjacent organs.

IVB: Spread of growth to distant organs.

References:

Page 736 to 737 Chapter 18 Obstetrics CMDT 2006 -Current Medical Diagnosis and Treatment. Edited by Lawrence M. Tierney, Jr. ,Stephen J. McPhee, Maxine A. Papadakis 45th edition Lange Publications.Mc Graw Hill

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