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Chapter-21 Cervical Cancer

BOOK TITLE: Ward Rounds in Obstetrics and Gynecology

Author
1. Muto Michael George
ISBN
9789352702398
DOI
10.5005/jp/books/18053_24
Edition
1/e
Publishing Year
2018
Pages
12
Author Affiliations
1. Harvard Medical School; Brigham and Women’s Hospital and the Dana Farber, Cancer Institute, Boston, Massachusetts, USA
Chapter keywords
Cervical cancer, examination under anesthesia, fertility sparing surgery, radical hysterectomy, simple extrafascial hysterectomy, brachytherapy, neoadjuvant chemotherapy

Abstract

This chapter presents discussion on cervical cancer in question and answer format. Risk factors for the development of cervical cancer include age at onset of sexual activity, multiple sexual partners, exposure to a high-risk sexual partner, a history of sexually transmitted disease, and a history of human papillomavirus (HPV) associated preinvasive vulvar or vaginal lesions. In cases of suspected cervical cancer, it is of paramount importance to obtain sufficient tissue to establish a definitive diagnosis. The key to the proper examination under anesthesia (EUA) is to measure the diameter of the cervical lesion and to assess the uterosacral and cardinal ligaments for nodular involvement of disease. A simple extrafascial hysterectomy removes only the uterus and cervix. A radical hysterectomy removes not only the uterus and the cervix, but also all parametrial tissue on either side of the cervix, along with a portion of the uterosacral ligaments, cardinal ligaments and the upper 1–2 cm of vagina. A radical hysterectomy affects the innervation of the bladder and may result in temporary urinary retention. Brachytherapy is a radiation therapy technique that places the radiation source in direct contact with the tissues to be treated. This allows the radiation oncologist to deliver very high doses to the epicenter of the tumor while sparing surrounding non-target tissues. Neoadjuvant chemotherapy is administered prior to definitive surgery for locally advanced cervical cancer. The therapy is administered in the hope that the tumor will regress sufficiently to allow resection to negative nodes and negative margins, thereby reducing the costs and complications associated with primary radiation therapy.

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