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CARCINOMA CERVIX
This study compared clinical examination to examination under anesthesia (EUA) for staging locally advanced cervical cancer in 62 patients. There was significant variation between the two methods. Upstaging occurred in 14 patients and downstaging in 12 patients after EUA. Staging changed in 26 patients overall. Parametrial assessment showed the highest discordance. EUA is recommended for staging, especially for parametrial assessment, as it reduces bias and variability compared to clinical examination alone. The authors conclude that EUA or other objective staging methods should be considered mandatory for accurate staging of locally advanced cervical cancer in India given its high prevalence.
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CARCINOMA CERVIX
- 1. COMPARISION OF CLINICALEXAMINATION VERSUS EXAMINATION UNDER ANAESTHESIA IN LOCOREGIONALLY ADVANCED CARCINOMA CERVIX- SINGLE INSTITUTIONAL REPORT Prof.Dr.R.Rajaraman.,M.Ch Prof.Dr.S.Subbiah.,M.Ch Dr.A.Joseph Stalin AntonyMuthu-M.Ch(PG) Centre for Oncology Govt Royapettah Hospital,Chennai.
- 2. Why this study? •Magnitude of problem in India • Carcinoma Cervix staged clinically. • High chance for bias and intra/interobserver variation. • Any bias in clinical examination can alter stage, treatment modality, prognosis, statistics,research work.
- 3. OBJECTIVE • Aim isto determine the variance in clinical staging. • By comparing clinical examination versus examination under anaesthesia in locaregionally advanced carcinoma cervix.
- 4. METHODOLOGY • Study Design: Prospective comparitive study. • Place :Govt.Royapettah Hospital, Chennai. • Period : Aug,2013-Aug,2014. • No of patients: 62
- 5. METHODOLOGY • Selection Criteria:carcinoma cervix patients- clinically staged-IB2,II,III,IVA – planned for EUA. • Study population : Low socioeconomic strata. Mean age :50.5 yrs.(36-64) • Data analysis done using Chisquare/Fisher’s exact test.
- 6. PARAMETERS COMPARED Clinical VsEUA • Size of tumour • Vaginal involvement • Parametrial involvement • FIGO Stage
- 7. CLINICAL STAGE • N= 62 • IB2 = 20 • IIA2 = 08 • IIB = 34 CLINICAL STAGE IB2 IIA2 IIB
- 8. IB2 POST EUA IB2 IB2 IIA2 IIB •Clinical IB2 = 20 Post EUA • IB2 = 12 P =0.001 • IIA2 =02 • IIB = 06
- 9. IIA2 POST EUA IIA2 IIA2 IIB •Clinical IIA2 = 08 Post EUA • IIA2=06 P=0.0357 • IIB = 02
- 10. IIB POST EUA IIB IIB IBI IB2 IIA1 IIA2 IIIB •Clinical IIB = 34 Post EUA • IIB = 18 • IB1 = 01 P=0.0001 • IB2 = 06 • IIA1 = 02 • IIA2 = 03 • IIIB = 04
- 11. RESULTS • Upstaging notedin 14 patients • Downstaging noted in 12 patients. • Variation in clinical finding without alteration of stage seen in 14 patients • Discordance between clinical and EUA seen in 40 patients(P<0.0001), highest in parametrial assessment. • Stage migration seen in 26 patients (p=0.0001) • Treatment modality changed from radiotherapy to surgery in 3 patients.
- 12. DISCUSSION • Is FIGOstaging relying only on clinical examination for staging purpose a standard? • Pitfalls in FIGO staging –carcinoma cervix Intra/inter observer variation Need for barium enema,IVP ? Paraaortic node ,pelvic node ?
- 13. CONCLUSION • EUA recommendedfor staging carcinoma cervix especially for parametrial assesment • Time to consider EUA/IMAGING/SURGICAL STAGING as prerequisite for staging ?
- 14. CONCLUSION • Locoregionally advancedcarcinoma cervix – problem of India( Death due to carcinoma cervix equals maternal deaths/year)- Indian guidelines for staging/treatment protocol through RCT need of the hour. thank u………..
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