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Staging Classifications and Clinical Practice Guidelines for Gynaecological Cancers

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Staging Classifications and Clinical Practice Guidelines for Gynaecological Cancers Pages 10/10/06 10:29 Page i Staging Classifications and Clinical Practice Guidelines for Gynaecological Cancers Emeritus Editor: JL Benedet Editors: Sergio Pecorelli, Hextan YS Ngan and Neville F Hacker Co-Editors: Lynne Denny Howard W Jones III John Kavanagh Henry Kitchener Ernest Kohorn Gillian Thomas I would like to thank L Zigliani for her contribution to this handbook. i Pages 10/10/06 10:29 Page ii Staging Classifications and Clinical Practice Preface The third edition of the Good Practice Guidelines on Gynaecologic Guidelines for Gynaecologic Cancers Cancers was a collaborative effort between FIGO and the Internation- al Gynecologic Cancer Society. Both organisations put women’s FIGO Committee on Gynecologic Oncology health and combat female cancers as their priority objectives. New L Denny, NF Hacker, J Gori, HW Jones III, HYS Ngan, S Pecorelli advances were added to this new edition. The guidelines are based on strongest available evidence which varies from topic to topic. The Chief Editors of First Edition evidence has been graded as follows: A – randomised controlled trial JL Benedet, MD B – prospective (cohort) study with a comparison group C – retrospective follow-up study S Pecorelli, MD, PhD D – cross sectional study However, guidelines on breast cancer have not been revised. It is Reprinted from envisaged that further revision will be needed in future. In the mean International Journal of Gynecology and Obstetrics, time, based on current evidence, these guidelines could serve as a 70 (2000) 207-312 good reference where adaptation to local use could be based on. Hextan YS Ngan Published in September 2000 by Elsevier Chairman of FIGO Committee on Gynecologic Oncology Chief Editor of Second Edition The International Gynecologic Cancer Society (IGCS) is pleased to be able to continue the collaboration with FIGO to develop treatment NF Hacker MD guidelines for gynaecologic malignancies. The guidelines for all pri- mary gynaecological sites have been updated, with significant recent HYS Ngan MD advances included in the text and in the bibliography. The final prod- JL Benedet MD uct is the result of input from many specialists in both organisations. These guidelines are intended to represent a reasonable synthesis of the current literature for each disease site, though they are not intend- ed to be absolutely prescriptive. Patient management always needs to be individualised, taking into account a patient’s general medical con- dition, her cultural environment, and the available expertise and technology. Neville F Hacker Chairman of the IGCS Guidelines Committee ii iii Pages 10/10/06 10:29 Page iv Contents 2. Cancer of the vagina...................................................................26 Preface 2.1 Staging ...................................................................................26 Principles of cancer staging................................................................1 2.1.1 Anatomy.....................................................................................26 Principles governing the development of good practice guidelines ..3 2.1.1.1 Nodal stations.............................................................27 2.1.1.2 Metastatic sites...........................................................27 1. Cancer of the vulva.......................................................................6 2.1.1.3 Histopathologic types.................................................27 1.1 Staging .....................................................................................6 2.1.1.4 Histopathologic grades...............................................27 1.1.1 Anatomy.......................................................................................6 2.1.1.5 Regional lymph nodes ...............................................27 1.1.1.1 Nodal stations...............................................................6 2.1.1.6 Distant metastasis.......................................................28 1.1.1.2 Metastatic sites.............................................................6 2.2 Introduction............................................................................29 1.1.2 Surgical staging classification .....................................................6 2.3 Screening ...............................................................................29 1.1.2.1 Regional lymph nodes .................................................6 1.1.2.2 Distant metastasis .......................................................6 2.4 Vaginal intraepithelial neoplasia (VAIN) ..............................29 1.1.2.3 Histopathologic types...................................................8 2.5 Invasive carcinoma ................................................................30 1.2 Introduction..............................................................................9 2.5.1 Treatment ...................................................................................31 2.5.1.1 Surgery .......................................................................31 1.3 Screening ...............................................................................10 2.5.1.2 Radiation therapy .......................................................31 1.4 Squamous cell carcinoma ......................................................10 2.5.2 Prognosis....................................................................................32 1.4.1 Presenting symptoms.................................................................10 2.6 Special situations ...................................................................32 1.4.2 Diagnosis ...................................................................................10 2.6.1 Adenocarcinoma ........................................................................32 1.4.3 Investigations .............................................................................11 2.6.1.1 Screening....................................................................32 1.4.4 Clinical practice guidelines........................................................11 2.6.1.2 Treatment ...................................................................32 1.4.5 Treatment ...................................................................................11 2.6.1.3 Prognosis....................................................................33 1.4.5.1 Treatment of vulvar intraepithelial neoplasia (VIN) 2.6.2 Vaginal melanoma .....................................................................33 or carcinoma in situ....................................................11 2.6.3 Sarcoma botryoides ...................................................................33 1.4.5.2 Invasive vulvar cancer ...............................................12 1.4.5.2.1 Microinvasive vulvar cancer ............................12 References ........................................................................................33 1.4.5.2.2 Early vulvar cancer...........................................12 3. Cancer of the cervix uteri ..........................................................37 1.4.5.2.2.1 Management of the primary lesion ............12 3.1 Staging ...................................................................................37 1.4.5.2.2.2 Management of groin lymph nodes ...........13 3.1.1 Anatomy.....................................................................................37 1.4.5.2.2.3 Groin dissection..........................................14 3.1.1.1 Primary site ................................................................37 1.4.5.2.2.4 Radiation fields and doses..........................15 3.1.1.2 Nodal stations.............................................................37 1.4.5.2.3 Advanced vulvar cancer ...................................15 3.1.1.3 Metastatic sites...........................................................37 1.4.5.2.3.1 Management of the groin Lymph nodes ....16 3.1.2 Rules for classification ..............................................................37 1.4.5.2.3.2 Management of the primary tumour ..........18 3.1.2.1 Clinical-diagnostic staging.........................................37 1.4.5.2.3.3 Radiation protocol......................................19 3.1.2.2 Post-surgical treatment – pathologic staging.............38 1.4.5.2.3.4 Close surgical margins ...............................19 3.1.3 Staging classification.................................................................38 1.5 Special situation.....................................................................19 3.1.3.1 Notes about the staging..............................................38 1.5.1 Vulvar melanoma.......................................................................19 3.1.3.2 Regional lymph nodes ...............................................40 1.5.2 Bartholin gland cancer...............................................................20 3.1.3.3 Distant metastasis.......................................................41 1.5.3 Paget’s disease ...........................................................................20 3.1.4 Histopathology...........................................................................41 1.6 Pathology ...............................................................................21 3.1.4.1 Histopathologic types.................................................41 References ........................................................................................22 3.1.4.2 Histopathologic grades...............................................41 iv v Pages
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