COMPARISION OF CLINICAL EXAMINATION VERSUS EXAMINATION UNDER ANAESTHESIA IN

LOCOREGIONALLY ADVANCED CARCINOMA CERVIX- SINGLE INSTITUTIONAL REPORT

Prof.Dr.R.Rajaraman.,M.ChProf.Dr.S.Subbiah.,M.Ch

Dr.A.Joseph Stalin AntonyMuthu-M.Ch(PG)Centre for Oncology

Govt Royapettah Hospital,Chennai.

Why this study?

• Magnitude of problem in India

• Carcinoma Cervix staged clinically.

• High chance for bias and intra/interobserver variation.

• Any bias in clinical examination can alter stage, treatment modality, prognosis,

statistics,research work.

OBJECTIVE

• Aim is to determine the variance in clinical staging.

• By comparing clinical examination versus examination under anaesthesia in locaregionally advanced carcinoma cervix.

METHODOLOGY

• Study Design : Prospective comparitive study.

• Place :Govt.Royapettah Hospital, Chennai.

• Period : Aug,2013-Aug,2014.

• No of patients: 62

METHODOLOGY

• Selection Criteria: carcinoma cervix patients- clinically staged-IB2,II,III,IVA – planned for EUA.

• Study population : Low socioeconomic strata. Mean age :50.5 yrs.(36-64)

• Data analysis done using Chisquare/Fisher’s exact test.

PARAMETERS COMPAREDClinical Vs EUA

• Size of tumour

• Vaginal involvement

• Parametrial involvement

• FIGO Stage

CLINICAL STAGE

• N = 62

• IB2 = 20

• IIA2 = 08

• IIB = 34

CLINICAL STAGE

IB2IIA2IIB

IB2 POST EUA

IB2

IB2IIA2IIB

• Clinical IB2 = 20

Post EUA

• IB2 = 12 P =0.001• IIA2 =02

• IIB = 06

IIA2 POST EUAIIA2

IIA2IIB

• Clinical IIA2 = 08

Post EUA

• IIA2=06 P=0.0357

• IIB = 02

IIB POST EUA

IIB

IIBIBIIB2IIA1IIA2IIIB

• Clinical IIB = 34

Post EUA

• IIB = 18

• IB1 = 01 P=0.0001• IB2 = 06

• IIA1 = 02

• IIA2 = 03

• IIIB = 04

RESULTS• Upstaging noted in 14 patients

• Downstaging noted in 12 patients.

• Variation in clinical finding without alteration of stage seen in 14 patients

• Discordance between clinical and EUA seen in 40 patients(P<0.0001), highest in parametrial assessment.

• Stage migration seen in 26 patients (p=0.0001)

• Treatment modality changed from radiotherapy to surgery in 3 patients.

DISCUSSION

• Is FIGO staging relying only on clinical examination for staging purpose a standard?

• Pitfalls in FIGO staging –carcinoma cervix Intra/inter observer variation Need for barium enema,IVP ? Paraaortic node ,pelvic node ?

CONCLUSION

• EUA recommended for staging carcinoma cervix especially for parametrial assesment

• Time to consider EUA/IMAGING/SURGICAL STAGING as prerequisite for staging ?

CONCLUSION

• Locoregionally advanced carcinoma cervix – problem of India( Death due to carcinoma cervix equals maternal deaths/year)- Indian guidelines for staging/treatment protocol through RCT need of the hour.

thank u………..

CLINICAL EXAMINATION,CXR EUA + CECT ABDOMEN/PELVIS

IA/IB1

Fertility/Non

fertility surgery

RISK STRATIFICAT

ION

RT IF

NEEDED

IB2/IIA2/IIB

NO NODE

S

NEOADJUVANT CHEMO

GOOD RESPONSE

SURGERY

RT IF NEEDED

POOR RESPONSE

RADICAL CHEMO RT

PELVIC NODES

RADICAL

CHEMO RT

IIIIA/IIIB

RADICAL CHEMORT

IVA

CYSTO/PROCTOSCOPY

DIVERSION/PELVIC

EXENTERATION IF NEEDED

CHEMORT

IV B

PALLIATIVE CHEMO