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Re: Early Invasive Cx CAFrom: Brickster0@aol.comTue May 14 21:59:33 1996
hribot@obd writes: I am interested in your opinion regarding the following patient, especially the oncologists among us. This is a 32 yo para 0020 who presented for annual exam and Pap and Gyn consult seen by one of our CNMs with hx of "2 periods last month," otherwise no other complaints. Exam was normal to the naked eye but Pap came back HGSIL/Carcinoma in situ. Colposcopy was unsatisfactory due to small cervical os but all the acetowhite epith and punctation/mosaic was clustered around the os. No atypical vessels seen. Colposcopic biopsies showed "focal microinvasive squamous cell carcinoma, and "extensive squamous cell carcinoma in situ with endocervical gland involvement;" ECS was negative. Due to the small lesion size and the need for characterizing invasion, a cold knife cone was done which showed definite invasion from 3 to 5 mm with areas of confluence and capillary space involvement (2nd Path opinion by Dr. Majmudar @ Emory concurs). The patient went for a 2nd opinion to another generalist ob/gyn who did a one week post cone exam and had a phone consult only with a Gyn oncologist in town who did not examine the patient but merely read her original cone path report (which showed focal involvement of the ectocervical margin with invasive stuff) and she was then told that she could have q 3 month Paps and she would be OK. However, in the next breath he told the pt. (her version) that if she did opt for hysterectomy, he would do a "radical." My question : Do you feel the literature risk of + pelvic nodes of 4.8 % (Berek & Hacker, 1989 ed.) is valid and should she have node dissection. Do any of you feel preop CT adds anything, in light of the significant false + and false neg.rates? Hugo Cartersville, GA Private practice Hugo, who did you speak to? Atlanta has more gyn oncologist/sq ft than any town I know. If I understand your case correctly, you have at least a Stage Ia1 cervical cancer, you certainly may have quite a bit more. Conization for a microinvasive cervical cancer is conservative treatment, but this young lady has yet to have a diagnosis. A CAT scan won't give you any help unless they see some large node >1cm. MRI isn't great in the pelvis secondary to respiratory motion artifact. She needs at least reconization for a diagnosis. Dr. Maj is a good pathologist, but this young lady needs the input of a oncologist to "lay hands" on her. It is a short commute. Don't take this headache on yourself. One Georgia generalist to another E. F. Bills M.D. Private Practice Atlanta, GA
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