••• Chapter 43^ Cervical Lesions and Cancer^435
❍ What is the incidence of pelvic lymph node metastasis for squamous cell carcinoma of the cervix invading
1 to 3 mm and for lesions invading 3 to 5 mm?
<1% and 4%, respectively.
❍ What is the possibility of lymph metastasis in stage II disease?
The prevalence of lymph node disease correlated well with the stage. Lymph node involvement in stage II is
between 25% and 40%; in stage III, it is assumed that at least 50% have positive nodes.
❍ For stage IB1 and early stage IIA disease, which therapy is more effective, radical hysterectomy, or radiation
therapy?
For these stages, the two modalities are considered equivalent therapeutically. Choice of therapy is dependent on a
wide variety of factors.
❍ What is the 5-year survival for stage I cervical cancer?
Approximately is 90% overall. Five-year survival when nodes are negative is often >90%. When nodes are involved,
survival ranges from 20% to 75% depending on the number, size, and location of the positive nodes.
❍ The cardinal ligaments are exposed during a radical hysterectomy when what two pelvic spaces are developed?
The paravesical space anterior to the cardinal ligament and the pararectal space posteriorly.
❍ Ureterovaginal and vesicovaginal fistulas occur in what percentage of patients undergoing radical
hysterectomy?
1% to 2% and <1%, respectively.
❍ What is the difference between modified radical (class II) and radical hysterectomy (class III)?
The purpose of the class II hysterectomy is to remove more paracervical tissue while still preserving most of the
blood supply to the distal ureters and bladder. The uterine artery just ligated medial to the ureters. The class III
procedure is a wide radical dissection of the parametrial tissues. The uterine artery is ligated at its origin on the
internal iliac artery so lateral from the ureters.
❍ Define the reference points A and B used in radiation treatment planning for cervical cancer.
Point A: 2 cm lateral and 2 cm superior to the external cervical os, approximating the location where the uterine
artery crosses the ureter.
Point B: 3 cm lateral to point A, corresponding to the pelvic wall.
❍ The standard unit for measuring absorbed radiation is the gray (1 joule/kg). How many rads are equivalent
to 1 Gy?
100 rads equal to 1 Gy.
❍ What dosage of radiation is required to sterilize microscopic disease?
4000 to 5000 cGy will sterilize over 90% of occult tumor deposits.