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Re: Abnormal smear post radiotx for Ca CervixFrom: Sejfulah Perva (pervaans@bih.net.ba)Wed Oct 13 17:04:59 1999
At Sat, 02 Oct 1999, A.C. Evans wrote: > >On Fri, 1 Oct 1999 09:42:52 -0500, mstmy@tm.net.my (John Teo) wrote: > >>I have a 61 years old patient who was diagnosed with squamous cell >>carcinoma of the cervix stage 1b bulky and was treated with radiotherapy >>in 1997. She remained well on follow up and asymptomatic.Routine follow >>up pap smear currently was reported as "Atrophic smear showing marked >>post radiation changes with a few groups of rather degenerate malignant >>cells, highly suspicious of recurrence." >>On examination the vaginal wall are adherent and plastered together >>anteriorly and posteriorly.The cervix can`t be visualised at all. There >>was however no obvious growth. > >Where was the Pap from, then? > >>My Question is what is the next course of action in confirming the >>suspicion of recurrence? > >Send to a gyn oncologist. > >>1) Will a colposcopy be adequate in confirming or refuting the >>diagnosis? > >No. > >>2)Or instead will a examination under anaesthesia be better to break >>down the adhesions and attempt made to examine the cervix and if >>necessary a biopsy performed? > >Yes. Needs Tru-Cut needle biopsies and perhaps laparoscopy. > >>3)What is the role of CT scan in the diagnosis of recurrences? > >Not good, but it is a reasonable test to evaluate extent of disease. >That is, to evaluate for hydroureter or adenopathy or liver mets. I >also get MRI if planning an exenteration to look for sidewall >invasion. > >She needs prompt evaluation because she may be a candidate for >exenterative (curative) surgery. Don't delay. > >Craig Evans, MD, PhD >Director, Gynecologic Oncology >Vince Lombardi Cancer Clinic >Milwaukee, WI
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