QuestionI was diagnosed with the above and had a total vaginal hysterechtomy, performed by my gynecologist. The cancer was said to be contained only in the lining of ther cervix and hadn't spread to the uterus. No other parts were removed. I have heard "hearsay?" that adenocarcinoma can jump (so to speak), and also be found in the lymph nodes. Is this true and if so what is the likely hood of it? Should I see an onocologist regarding this? Is there anything else you can tell me about this type of cancer?
Thank you,
Margo
Answerany cancer jump as you said to lymph nodes we call this metastasis and invasion, it is available for the type of cancer that you had or any other cancer.
usually we use a staging for an evaluation including a preoperatory staging [ct or MRI] and a post operatory staging with exploration, if it did spread around in the lymph nodes the surgeon can feel it, or see it but sometimes the size of the tumor is so small that it can not be seen, but the pathology will tell more about it and usually you wait 15 days to know the final results.
Following the surgery depending on the staging but in you case I think a chemotherapy might be needed to make sure that every tumoral cells are killed.
After any cancer there is recurrences meaning the cancer either can come back or the small cells that cannot be seen grow, therefore we talk about a three years and five years survival rate, after five years if you do not have any signs of cancer it mean you are cancer free and very very low risk of recurrences.
There are several types of adenocarcinoma. About 60 percent are the endocervical cell type, 10 percent each are of endometrioid and clear cell carcinomas, and 20 percent are adenosquamous carcinoma.
pre-invasive cervical cancer may develop over a period of months or years after the cervix is infected with the human papilloma virus (HPV). This early lesion-known as mild dysplasia or cervical intraepithelial neoplasia (CIN) Grade 1 or now called low-grade squamous intraepithelial lesion (LGSIL)-can progress to moderate dysplasia (CIN-2), then to severe dysplasia and carcinoma in situ (CIN-3) or collectively known now as a high-grade squamous intraepithelial lesion (SIL) and eventually to invasive carcinoma. Most physicians believe that about two-thirds of all cases of high-grade SIL progress to invasive cancer if left untreated. This transformation takes anywhere from 2 to 30 years, about 10 years on the average.
Once the cervical cancer becomes invasive, it can spread locally to the upper vagina and into the tissues surrounding the upper vagina and the cervix (the parametrium). Eventually it grows toward the pelvic sidewall, obstructing the tubes (ureters) that drain urine from the kidney to the bladder. It can also spread to the bladder and rectum.
Cervical tumor cells can invade the lymphatic system and spread to the lymph nodes around the vessels on the pelvic wall. Eventually they may spread to the iliac lymph nodes higher in the pelvis, the aortic lymph nodes, the nodes above the collarbone and occasionally to the groin nodes.
Metastases can also spread through the bloodstream to the lower vagina, vulva, lungs, liver and brain. Distant metastases are more common in women with cancer spread to the lymph nodes or higher stage cancer. Invasion of the pelvic nerves is common in advanced cases. There may also be spread within the abdomen when the tumor penetrates the full thickness of the cervix.
Most gynecologic oncologists use the FIGO (International Federation of Gynecologists and Obstetricians) classification. The divides the disease into five stages, with further divisions in each stage. A carcinoma in situ is Stage 0. The cancer is confined to the cervix in Stage I. In Stage II, the disease either extends beyond the cervix but not to the pelvic sidewall, or involves the vagina but not the lower third. A Stage III carcinoma extends to the pelvic sidewall, involves the lower third of the vagina or obstructs one or both of the ureters. In Stage IV, the cancer has spread to distant organs beyond the true pelvis or involves the lining of the bladder or rectum.
Several radiation techniques may be used depending on the stage of the disease-external beam therapy and intracavitary therapy: the insertion of radioactive substances around the tumor or into the tumor (interstitial radiation). Intracavitary radiation may be of two types low-dose rate and high-dose rate (see Radiation Therapy chapter).
Chemotherapy
It is now standard therapy to give chemotherapy simultaneously with radiation therapy in women with advanced cervical cancers. This treatment is currently being investigated for women at high risk for recurrent disease (regardless of the stage) or for those with multiple pelvic lymph node or aortic lymph node metastases.
STAGE O (Adenocarcinoma)
Standard Treatment
Adenocarcinoma in situ (confined to the surface of the cervix) is often difficult to diagnose. The diagnosis is usually made with a cervical biopsy or an endocervical curettage. In all cases a conization is required to rule out a truly invasive lesion.
For women who may want to have children, a LEEP or cone biopsy may cure the disease if the surgical margins, or edges, do not show any evidence of disease. Even so, adenocarcinoma in situ or an invasive adenocarcinoma is occasionally found in the residual cervix even if the cone biopsy has negative margins.
For those who have completed childbearing, the treatment of choice is a simple vaginal or abdominal hysterectomy.
Five-Year Survival
100 percent.
STAGE I
Stage I is cancer confined to the cervix.
STAGE IA1
Stage Ia involves a carcinoma of the cervix diagnosed only microscopically. All visible lesions, even those with minimal invasion, are Stage Ib. Stage I is further divided into two stages based on the depth of invasion of the cervix. In Stage Ia there is less than 3 mm of invasion and the invasion is less than 7 mm wide. When the depth of invasion is less than 3 mm from the surface and there is no vascular space involvement, a hysterectomy is often recommended. However, a cervical LEEP or conization may be curative if the edges (margins) of the cone biopsy are free of disease and if there is no vascular space involvement. This is appropriate therapy for those women who want to preserve their fertility or who want to avoid a hysterectomy.
Standard Treatment
Women with this stage of disease are usually treated with a cone biopsy (a large cone-shaped biopsy of the cervix) or a vaginal or abdominal hysterectomy, with or without removal of the ovaries.
Five-Year Survival
100 percent.
STAGE IA2
The depth of stromal invasion is greater than 3 mm and less than 5 mm from the surface of the cervix. It also must be less than 7 mm wide.
Standard Treatment
In the United States, women with cancer invading greater than 3 mm into the cervix or those with invasive cancer less than that, but with blood vessel involvement, are treated like those women with Stage Ib1 disease.
Five-Year Survival
85 to 95 percent.
STAGE IB
Lesions are larger than Stage Ia2, but are still confined to the cervix.
STAGE IB1
Cervical cancer confined to the cervix, but no greater than 4.0 cm in size.
STAGE IB2
Cervical cancer confined to the cervix, but greater than 4 cm in size.
Standard Treatment
There are two options for treatment. A radical hysterectomy may be done, with removal of the lymph nodes from the blood vessels from both sides of the pelvis and from around the aorta. An alternative is external beam radiation (given in divided doses five days a week for five weeks) followed two weeks later by intracavitary or interstitial radiation (low-dose or high-dose rate). Both options result in an equal rate of cure. The choice depends on available local expertise, the age of the patient and ones medical condition. Small lesions (stage IB1) are usually operated on while large ones are often treated with surgery or radiation. Women who have metastatic disease in the removed lymph nodes are frequently treated with external beam radiation therapy to the affected area following surgery.
A radical abdominal hysterectomy and a bilateral pelvic and aortic lymph node dissection is usually performed through either a midline abdominal incision or a large lower transverse abdominal incision. However, more recently, a number of gynecologic oncologists are performing the same operation using minimally invasive surgical techniques (laparoscopy). The entire procedure is performed through four to five small incisions in the abdominal wall. One just below, the second above the naval, the third just above the pubic bone, and the other two on opposite sides of the pelvis. Although this procedure is still investigational, as the technique is learned by more laparoscopists, it will become more widely available. Its limitations are primarily based on the patient's weight as obese women are not good candidates. There are also a number of gynecologic oncologists who believe that the lymph nodes should be removed laparoscopically and the radical hysterectomy performed through the vagina.
Cervical cancers greater than 4 cm (stage Ib2) confined to the cervix may be treated with surgery alone, radiation therapy followed by surgery six weeks later, or radiation therapy and chemotherapy alone, or chemotherapy followed by radical hysterectomy.
Five-Year Survival 70 to 95 percent.
STAGE II
The cancer is one that either extends beyond the cervix (but not to the pelvic sidewall) or involves the vagina (but not the lower third).
STAGE IIA
In Stage IIa there is no obvious involvement of the tissue surrounding the cervix (parametrium), but there is involvement of up to the inner two-thirds of the vagina.
Standard Treatment
Treatment with either a radical hysterectomy and removal of the lymph nodes or external beam radiation therapy followed by intracavitary or interstitial radiation with chemotherapy is standard.
Women with large lesions of the cervix are sometimes managed with preoperative radiation therapy, hysterectomy and lymph node dissection.
Women who have metastatic disease in the lymph nodes are often given external beam radiation therapy to the pelvis and sometimes the para-aortic region after surgery with or without chemotherapy.
Five-Year Survival
Approaching 70 to 95 percent.
STAGE IIB
There is obvious parametrial involvement, but no extension to the pelvic sidewall.
Standard Treatment
External beam radiation therapy may be given in divided doses over five weeks with concurrent chemotherapy, followed by intracavitary or interstitial radiation.
Five-Year Survival
65 to 80 percent.
Investigational
A new radiation technique that is currently being studied is known as high-dose rate brachytherapy, which allows for shorter treatment times in an outpatient or office setting.
Hyperthermia, a technique using radiation therapy and heat, is also being studied.
STAGE IIIA or IIIB
Stage III is defined as carcinoma that extends to the pelvic sidewall, involves the lower third of the vagina or obstructs one or both ureters. Stage IIIa means there is no extension to the pelvic sidewall, but the tumor involves the lower third of the vagina. In Stage IIIb, there is extension to the pelvic sidewall, obstruction of one or both ureters, or there is a non-functioning kidney.
Standard Treatment
External beam radiation therapy with chemotherapy followed by intracavitary or interstitial radiation therapy is the standard therapy.
Five-Year Survival
40-60 percent.
Investigational
Same as for Stage IIb.
STAGE IV
Stage IV is defined as cancer that has spread to distant organs beyond the true pelvis or involves the lining of the bladder or rectum.
STAGE IVA
Stage IVA means that a biopsy has shown that either the lining of the bladder or the rectum is involved with cancer.
Standard Treatment
This stage is usually treated with radiation therapy and chemotherapy or by the surgical removal of the uterus, the vagina and the bladder and/or rectum (pelvic exenteration).
Five-Year Survival
20 to 30 percent.
STAGE IVB
In Stage IVb there is spread to distant organs.
Standard Treatment
Radiation may be used to relieve the symptoms of pelvic disease or isolated distant metastases. Several chemotherapy drugs are useful for treating cervical cancer, but they are rarely curative. They include cisplatin or carboplatin, which has a response rate of 15 to 25 percent, and ifosfamide, which has a response rate of 30 percent.
Combination chemotherapy, including cisplatin + etoposide + bleomycin, has a response rate of about 50 percent. Other drug combinations that have been used in women with metastatic disease include mitomycin-C + bleomycin + cisplatin, carboplatin + ifosfamide, cisplatin + ifosfamide with or without bleomycin.
Investigational
Many of the drugs used in the standard treatment are being tested in different combinations and doses.
TREATMENT FOLLOW-UP
A Pap smear and careful examination of the pelvis, abdomen and lymph nodes is performed every three months for the first two years after treatment, and then every six months for three more years.
Routine chest x-rays and pelvic and abdominal CT scans are not warranted in the absence of symptoms.
The serum levels of carcinoembryonic antigen and/or squamous cell carcinoma antigen in the blood should be measured at each visit if they were elevated before treatment.
RECURRENT CANCER
Symptoms of recurrent cervical carcinoma may include vaginal bleeding or discharge, pain in the pelvis, back or legs, leg swelling (edema), chronic cough and weight loss.
Cervical cancer can recur in the vagina, pelvis, lymph nodes, lung, or liver.
If radiation was not given previously, recurrences that are confined to the pelvis may be treated with external beam radiation with chemotherapy and intracavitary or interstitial radiation therapy.
If radiation therapy was already given, the only option is the removal of the vagina, uterus, and the bladder and/or rectum with the creation of an artificial bladder-a pelvic exenteration. The five-year survival rate after a pelvic exenteration is about 50 percent.
Women with recurrent tumors that cannot be surgically removed or with metastatic disease are usually treated with chemotherapy. Commonly used drugs include single agent cisplatin or carboplatin. Other regimens include cisplatin or carboplatin + ifosfamide, vincristine + mitomycin-C + bleomycin + cisplatin and bleomycin + mitomycin-C + 5-fluorouracil.
Those with unresectable pelvic disease may be re-irradiated with interstitial radiation or given pelvic arterial chemotherapy.
I think yes you should be followed by an oncologist and you gyn, follow up is very important and in any changes or evolution will need immediate action either chemo, surgery, radiotherapy.
hope this answers your question
thanks
