[Seetal]

a 29 yr old woman, gravida2, para2, had a liquid-based thin layer cervical pap smear performed in the office a week ago. a high grade squamous intra-epithelial lesion was reported. HPV typing was positive for serotypes 16 & 18. she returned to the office n underwent colposcopically directed cervical biopsy. the entire transformation zone was seen with no lesion entering the endocervical canal. a specimen from a biopsy of a lesion at 6 o'clock on the cervix exhibited abnormal vessels and mosaicism. the histologic report showed full-thickness dysplastic epithelial changes with malignant cells that had penetrated the basement membrane and had invaded the lymphatics. which of the following procedures would be considered appropriate in identifying the stage of her disease?

a) intravenous pyelogram
b) laparoscopy
c) exploratory laparotomy
d) lymphangiogram
e) lymphadenectomy

 

[Mondoshawan]

I would answer E) lymphadenectomy.

If it has invaded the lymphatics, you'd want to take out the proximal nodes and make sure it hasn't gotten there. I think A) iv pyelogram is the next most tempting choice, since that would rule out stage t3b, invasion of the ureters and kidney as a tumour spreads to the pelvic wall; however, if it hasn't spread into the uterus yet, so that doesn't seem like a consideration. Clinically, I'd get an abd ct and a cxr to be sure about ruling out distant metastasis, but those weren't answer choices...

 

[tkourkou]

Staging of cervical cancer is always clinical but may include an IVP to rule out penetration of ureters, x-ray, cystoscopy and sigmoidoscopy. A CT and MRI cannot be used for staging.

The most common stage presenting is stage I.

Infiltration of the lymphatics is not taken into consideration for cervical cancer staging.

thus I would go with choice A.

 

[Seetal]

thank u tkourkou

the answer's indeed A (IVP).... if there was a simpler way, it'd be digital examination on clinical examination. ive tried that a few times.