Staging of cervical cancer - Copy.pptx

cervical cancer

1. Staging of cervical cancer Dr Preeti Kumari

2. introduction Staging of carcinoma cervix is the oldest staging system in oncology practice First FIGO consensus staging came in 1950 Initial staging system largely considered it as a local pelvic disease Initially it was surgically staged Recent staging systems were vastly clinical with ancillary diagnostic tools Previous modification was done in 2009.

3. 2009 FIGO staging pit falls B ased on clinical examination No nodal involvement considered 1B1 is a very broad category No imaging included No pathology included

4. Figo staging 2018 – salient features The horizontal dimension is no longer considered in defining the upper boundary of a Stage IA carcinoma. The diagnosis of Stage IA1 and IA2 carcinomas is made on microscopic examination of a surgical specimen, which includes the entire lesion. The margins of an excision specimen should be reported to be negative for disease. Although it is stated in the FIGO document that if the margins of the cone biopsy are positive for invasive cancer with a tumour with dimensions of IA carcinoma, the patient is assigned to IB1 in practice. In the event that the margins of a cone/ loop biopsy are positive for disease, a repeat cone/ loop biopsy is required to stage the patient.

5. Figo staging 2018 – salient features Stage IB has been sub-divided into IB1, IB2 and IB3 based on maximum tumour size. The revised 2018 system includes nodal status; the presence of nodal involvement in a tumour of any size upstages the case to Stage IIIC, with IIIC1 indicating pelvic and IIIC2 indicating para-aortic nodal involvement.

6. IMAGING Imaging evaluation may now be used in addition to clinical examination where resources permit The revised staging permits the use of any of the imaging modality according to available resources i.e USG,CT,MRI,PET to provide information about tumor size,nodal status and local/systemic spread The goal is to identify the most appropriate method and to avoid dual therapy with surgery and radiation as this has the potential to greatly augment morbidity

7. PATHOLOGY Pathology report is an important source for accurate assessment of the extent of disease The stage is to be allocated after all imaging and pathology reports are available Pathological findings supersede imaging and clinical findings. LVSI does not change the stage of the disease.

8. Stage 1-limited to cervix It is divided into stages IA and IB, based on the size of the  tumor  and the depth of tumor invasion. Stage IA is subdivided based on the depth of tumor invasion. In stage IA1, the cancer is not more than 3 millimeters deep. In stage IA2, the cancer is more than 3 but not more than 5 millimeters

9. Stage 1 b- invasive ca with measured deepest invasion >5 MM Stage IB1:  The tumor is 2 centimeters or smaller and the deepest point of tumor invasion is more than 5 millimeters.

10. STAGE 1B2 AND 1B3 In stage IB2, the cancer is larger than 2 centimeters but not larger than 4 centimeters. In stage IB3, the cancer is larger than 4 centimeters (>4 cm )

11. Comparison of figo stagING

12. STAGE-ii Largely remain unchanged

13. Stage ii – invades beyond the uterus but not extended onto the lower 1/3 rd of vagina or to the pelvic wall Stage IIA – involvement limited to upper 2/3 rd of the vagina without parametrial invasion In stage IIA1, the cancer is 4 centimeters or smaller. In stage IIA2, the cancer is larger than 4 centimeters.

14. In STAGE IIB , cancer has spread from the cervix to the tissue around the uterus i.e with parametrial invasion but not upto the pelvic wall

15. STAGE III Has Stage IIIC compared to early staging Stage IIIA AND IIIB remain unchanged Stage IIIC includes imaging or pathologic information as well to diagnose pelvic and/or para aortic lymph node involvement including micro-metastasis irrespective of tumor size and extent

16. Comparison of figo stage iii

17. Stage iii – involves the lower third of vagina and/or extends to the pelvic wall and/or causes hydronephrosis or non functioning kidney and/or involves pelvic and/or para aortic lymph nodes STAGE IIIA-Involves lower third of vagina ,with no extension to the pelvic wall

18. STAGE IIIB- Extension to the pelvic wall and /or hydronephrosis or non functioning kidney

19. STAGE III C-Involvement of pelvic and/or paraaortic lymph node (including micrometastasis ),irrespective of tumor size and extent Stage IIIC1-Pelvic lymph node metastasis only Stage IIIC2-Para aortic lymph node metastasis

20. Stage iv- extended beyond the true pelvis or has involved the mucosa of bladder or rectum Stage IVA-Spread of the growth to adjacent organs Stage IV B- Spread to distant organs

21. Thank you

22. Tumor size ASSESSMENT Can be done by Imaging studies-USG scan CT scan MRI,PET Physical examination-Clinical examination Under anaesthesia interobsever variability Pathological evaluation-Depth of invasion horizontal spread multifocal disease Third dimension

23. Appendix Microscopic disease (1A) now considers only deep stromal invasion disregarding horizontal spread Early clinically visible tumor (1B) now incorporates microscopic finding and imaging as well as depending upon availability 1 B is further divided into I B1,1B2,1B3 ,depending upon size of tumor Addition of 1B3 is new to this staging system.