438 Obstetrics and Gynecology Board Review •••
❍ When invasive cervical cancer is incidentally discovered following a simple hysterectomy, what is the most
common preoperative diagnosis?
Cervical dysplasia.
❍ A simple hysterectomy is performed and invasive cervical cancer is incidentally discovered. What are the
therapeutic options?
Patients who are good candidates of radical surgery and who had small lesions with uninvolved surgical margins
can be treated with radical parametrectomy, upper vaginectomy, and pelvic lymphadenectomy. All others should
receive chemoradiation therapy.
❍ Is conservation of the ovaries appropriate for young patients undergoing radical hysterectomy for stage IB
adenocarcinoma of the cervix?
Yes. If the ovaries appear grossly normal. The incidence of ovarian metastasis is <2%.
❍ What is the incidence of vesicovaginal fistula formation following radiation therapy for cervical cancer with
bladder invasion?
4% with 5-year survival up to 30%.
❍ What procedure is often considered prior to initiating radiation therapy for locally advanced cervical cancer
complicated by a rectovaginal fistula?
A diverting colostomy is often recommended to avoid sepsis.
❍ What is the 1-year survival rate following cervical cancer recurrence?
Approximately 15%.
❍ What is the therapy of choice for an isolated vaginal cuff recurrence following radical hysterectomy?
External beam radiation therapy followed by brachytherapy. Exenteration is generally reserved for patients who
have previously received radiation.
❍ What criteria should be met prior to surgically exploring a patient for an exenteration?
- Central pelvic disease without evidence of extension to the pelvic wall.
- No evidence of distant disease.
- A physically and emotionally fit patient.
❍ What clinical triad is strongly indicative of surgically unresectable recurrent cervical cancer?
- Unilateral leg edema.
- Sciatic pain.
- Ureteral obstruction.
❍ What percentage of patients explored for an exenteration will be found to have unresectable disease?
Approximately half. This is in part due to the limitations of the pelvic examination when radiation fibrosis of the
parametria is present.