LWBK1006-23 LWW-Govindan-Review December 12, 2011 19:10
Chapter 23•Gynecologic Cancers 325(cystoscopy, proctoscopy). Because cervical cancer is primarily a disease of
the developing world, staging procedures have been kept simple to allow
consistency staging throughout the world. Specific technology, such as
CT and PET, is often used for treatment planning in the United States but
should not be the basis for changing the stage.Answer 23.2.14. The answer is C.
For patients with small stage IB1 tumors, either radiation or radical hys-
terectomy with lymphadenectomy is appropriate. Factors such as patient
preference, anesthetic, and surgical risks should be considered. Surgical
treatment tends to be preferred for young women with small tumors
because it permits preservation of the ovaries and likely better vaginal
function. Radiation invariably leads to menopause with loss of ovarian
hormone production and possible vaginal stenosis. Simple hysterectomy
would be considered inadequate therapy for this size and stage of cancer.
Chemoradiotherapy would typically be indicated for patients with more
advanced cancers. Brachytherapy alone would also be inadequate because
the patient is at risk for nodal involvement, and external beam therapy
would also be indicated to treat the nodal area at risk.Answer 23.2.15. The answer is B.
Several randomized trials have demonstrated a benefit to the addition of
chemotherapy, to standard radiation therapy, for treating women with
locoregionally advanced cervical cancer. Based on these trials, regimens
that are commonly used in practice include 5FU with cisplatin and concur-
rent radiation, and weekly cisplatin with radiation. None of the combined
chemotherapy and radiation trials included the use of carboplatin. Hys-
terectomy following radiation and chemotherapy is no longer considered
routine.Answer 23.2.16. The answer is D.
This patient has developed an apparently isolated central pelvic recur-
rence after combined chemoradiotherapy. Her only real curative option
is surgery and will likely require pelvic exenteration. Patients typically
receive the maximum tolerated dose of radiation during their primary
therapy, and further meaningful doses of radiation are usually not possi-
ble. Chemotherapy is typically palliative in nature only. Recent random-
ized trials have suggested improved survival with combination chemother-
apy over single-agent cisplatin, but this remains palliative.Answer 23.2.17. The answer is C.
All of the statements are correct except that vaginal cancers are thought
to be related to HPV in at least 60% to 65% of cases. DES is a syn-
thetic estrogen previously given to women during pregnancy primarily in
women with a history of miscarriage or premature birth. First reported
in 1971, an association between DES exposure in utero and clear cell
vaginal cancer was made. Few cases of cancer in DES-exposed women
have been reported in those aged more than 40 years, and these women