Staging for Cervical Cancer Can be done under anaesthesia WHO recommends downstaging Aim is to obtain adequate Histological specimen for conformation (  90% are SCC and % are adenocarcinoma) Stage IACancer confined to the cervix Stage IB Stage II ACancer beyond cervix extending to upper 1/3 vagina Stage II BCancer beyond the cervix extending to para-metrium

Stage III A - Cancer beyond the cervix extending distal portion of the vagina. Stage III B - Cancer beyond the cervix extending to pelvic side wall. Stage IV A/IV B - Cancer has spread to bladder/ rectum and can involve distant metastasis (in stage IV B)

N.BStage IB1 - diameter cancer < 4cm Stage IB2 - diameter cancer > 4cm Most operable cervical cancers are stage II A and Below: Aim of surgery is to remove entire margins of tumour and any metastatic disease in the pelvis.  Extended Hysterectomy and bilateral pelvic lymphadenectomy (“Wetheims” “Meigs”).

Remove uterus with its parematrium, cervix and paracervical tissue, vaginal cuff, Right and Left pelvic lymph nodes. Post-surgical radiotherapy must be offered to women with incomplete resection margins and those with metastatic pelvic nodes. Stage 1B 2 is best treated by initial radiation therapy before surgical intervention.

Complications Anaesthetic Haemorrhage Damage urinary/bowel systems Infection (UTI/Pelvic/Wound/Atelactosis) Lymphoecele DVT Preservation of ovaries Preservation of functional vagina Radiotherapy can be used to treat all stages of cervical cancer and is the only option available for the non-operable stage II B and above.