••• Chapter 43^ Cervical Lesions and Cancer^433
❍ If high-grade squamous intraepithelial lesions are left untreated over a period of several years, what
percentage will progress to invasive cancer?
Approximately 20%.
❍ What is the relative frequency of the two major histologic subtypes of cervical cancer?
Approximately 80% of cervical cancers are squamous cell carcinoma, and 15% are adenocarcinomas.
❍ What is the most common stage at diagnosis of cervical cancer?
Approximately half of patients with cervical cancer present with stage I disease.
❍ What epidemiologic risk factors have been identified for the development of cervical cancer?
Women in lower socioeconomic status, young age at first intercourse, multiple sexual partners, high parity, HIV
infection, and history of other sexually transmitted infections.
❍ What other modifiable risk factor has been clearly linked to an increased risk of cervical cancer?
Exposure to cigarette smoke. The relative risk of cervical cancer is increased two- to fourfold among cigarette
smokers compared with nonsmokers.
❍ A carcinoma 5 cm in diameter and clinically confined to the cervix is assigned what International Federation
of Gynecologists and Obstetricians (FIGO) stage?
According to the 2009 FIGO staging modifications, lesions clinically confined to the cervix and ≤4 cm in diameter
are designated stage IB1. Lesions >4 cm are classified as stage IB2.
❍ A carcinoma 3 cm in diameter and extended to the upper third of the vagina is assigned what FIGO stage?
According to the 2009 FIGO staging modifications, lesions with clinical involvement of the upper two-thirds of
the vagina, without parametrial invasion, <4 cm in greatest dimension are designated stage IIA1.
❍ A carcinoma 5 cm in diameter and extended to the upper third of the vagina is assigned what FIGO stage?
According to the 2009 FIGO staging modifications, lesions with clinical involvement of the upper two-thirds of
the vagina, without parametrial invasion, >4 cm in greatest dimension are designated stage IIA2.
❍ How do para-aortic lymph node metastases detected by computed tomography (CT) scan and confirmed by
thin-needle sampling affect staging?
This information helps to direct therapy, but it does not affect staging that is clinically assigned.
❍ What radiographic study has the highest sensitivity to detect para-aortic lymph node metastases?
Lymphangiogram, CT scan, and ultrasound were prospectively evaluated by the Gynecologic Oncology Group.
Sensitivities were 79%, 34%, and 19%, respectively. Specificities were 96%, 73%, and 99%, respectively.
❍ What diagnostic methods are accepted in the staging of cervical carcinoma?
Physical examination, colposcopy, cystoscopy, routine radiographs (chest X-ray), intravenous pyelogram (IVP),
proctoscopy, sigmoidoscopy, and barium studies of the large bowels. Other imaging or diagnostic methods such
as magnetic resonance imaging (MRI), computed tomography (CT), venography, arteriography, hysteroscopy,
laparoscopy or laparotomy, are NOT acceptable for staging determination.