CORRELATION OF LYMPH NODE METASTASES WITH STAGE & GRADE OF THE DISEASE IN CARCINOMA OF THE CERVIX Prof. Shaila Anwar Professor Obs & Gynae Lahore Medical & Dental College Lahore, Pakistan

Background 2nd most common after breast cancer 12% of all cancers in women Incidence rises sharply till age 45 Peak incidence 45-55 Years

Spread Local Extension Lymphatic involvement Hematogenous

Lymphatic Spread Primary Echelon node in pelvis Pelvic Nodes Para aortic Nodes

Lymphatic Drainage

Pelvic Nodal Involvement Stage-I 15% Stage-II 25% Stage-III 36- 50% Stage-IV >50%

Para Aortic Lymph Node Involvement Stage- I 8% Stage-II 20% Stage-III 30% Stage-IV 23%

Distant Nodal Involvement Left Scalene Node - involved One third of Patients with Paraaortic Metastasis

Objective To find out correlation of pelvic & para-aortic lymph node enlargement with clinical stage of carcinoma of cervix

Patients & Methods Cross Sectional analytical study June 2004 – May 2016 Deptt of Gynaecology Ghurki Trust Teaching Hospital Deptt of Radiology & Deptt of Clinical Oncology King Edward Medical University & Mayo Hospital Lahore

Patients & Methods 126 patients staged clinically Evaluation by USG & CT Scan Treatment record of RT was evaluated & Proforma was filled

Criteria of Lymph Node enlargement by CT/USG Lymph node involvement was considered to be present when: Node was 1.5 cm or more in diameter on CT Palpable enlarged nodes were seen on laparotomy

Results Stage of disease (n=126) IIA 15 11.90% IIB 31 24.6% Stage No. of Patients %age IIA 15 11.90% IIB 31 24.6% IIIA 40 31.7% IIIB 40 31.7%

Pelvic Lymph Node Involvement Stage of disease (n=126) Stage No. of Patients No. of Pts %age in this stage with the Nodes IIA 15 06 13% IIB 31 07 22.5% IIIA 40 09 22.5% IIIB 40 15 37.5%

Para Aortic Lymph Node Involvement (n=126) Stage No. of Patients %age IIA 0/15 0% IIB 3/31 9.67% IIIA 6/40 15% IIIB 13/40 32.5%

Histopathological Type (n=126) Large cell Non Keratinizing : 27.5% Large cell Keratinizing : 31.5% Small cell Keratinizing : 41%

Conclusion Small cell pathology increase possibility of nodal involvement Higher stage disease increase risk of para-aortic lymph node RT of para-aortic lymph node in small cell variety should be considered