1. 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

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

3. Spread
Local Extension
Lymphatic involvement
Hematogenous

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

5. Lymphatic Drainage

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

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

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

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

10. 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

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

12. 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

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

14. Pelvic Lymph Node Involvement
Stage of disease (n=126)
Stage No. of Patients No. of Pts %age
in this stage with the Nodes
IIA %
IIB %
IIIA %
IIIB %

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

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

17. 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