NSRH/CRH for
cervical cancer
Nerve-sparring
radical hysterectomy
Conventional
radical hysterectomy
Outcome
沒有顯著差異
Quality of
life 有顯著差異
Surgery
Indication: 1B to 2A
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Cardinal lig.
dissection is the key element
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Sympathetic T10-L2 Para-aortic nerve → Sup.
Hypogastric plexus
Parasympathetic L2-4 Pelvic splanchnic nerve→Inf. Hypogastric plexus (IHP)
(uterosarcral lig.)
Bladder br.
of IHP save part of vesicouterine lig.
Hypogastric
nerve lat. Border of mesoderm
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F. Mota: EORTC Classification of radical hysterectomy
Classification of radical hysterectomy adopted by the Gynecological
Cancer Group of the European Organization for Research and Treatment of
Cancer
1. Simple hysterectomy
(type I).
2. Modified radical hysterectomy (type II): Theuterus, paracervical tissues, and upper
vagina (1–2 cm) are removed after dissection of the uretersto the point of
their entry to the bladder. The uterine arteries are ligated, and the medial
half of the parametria (there was no consensus in this
concept) and proximal uterosacral ligaments are resected.
3.
Radical hysterectomy (type III): En bloc removal of the uterus with the upper third of the vagina along with the paravaginal and paracervical
tissues. The uterine vessels are ligated at their origin, and the entire width
of the parametria is resected
bilaterally. Removal of as much of the uterosacral ligaments as possible.
4.
Extended radical hysterectomy (type IV): Differ from the type III procedure—three fourths of the vagina and paravaginal tissue are excised.
5.
Partial exenteration (type V): The terminal ureteror a segment of the bladder
or rectum is removed along with the uterus and parametria (supralevatorial).
A)
Types II–V hysterectomies are completed witha systematic bilateral pelvic
lymphadenectomy,half the way along the common iliac artery downto the femoral
ring, including the presacral, bothexternal, internal, and interiliac and the
obturatornodes (at least to the level of the obturator nerve).
B)
Removal of the tubes and ovaries is not part ofradical hysterectomy per se.
F. MOTA, Int J Gynecol Cancer 2008, 18, 1136–1138
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FIGO stage
Endometrial
cancer, Figo stage II
|
Primary tumor (T)
|
|
|
|
TNM
|
FIGO
|
Surgical-Pathologic Findings
|
|
Categories
|
Stages
|
|
|
TX
|
|
Primary
tumor cannot be assessed
|
|
T0
|
|
No
evidence of primary tumor
|
|
Tis
|
|
Carcinoma
in situ (preinvasive carcinoma)
|
|
T1
|
I
|
Cervical
carcinoma confined to the cervix (disregard extension to the corpus)
|
|
T1a
|
IA
|
Invasive
carcinoma diagnosed only by microscopy; stromal invasion with a maximum depth
of 5.0 mm measured from the base of the epithelium and a horizontal spread of
7.0 mm or less; vascular space involvement, venous or lymphatic, does not
affect classification
|
|
T1a1
|
IA1
|
Measured stromal invasion ≤ 3.0 mm in depth and ≤ 7.0 mm in horizontal
spread
|
|
T1a2
|
IA2
|
Measured stromal invasion > 3.0 mm and ≤ 5.0 mm with a
horizontal spread ≤ 7.0 mm
|
|
T1b
|
IB
|
Clinically
visible lesion confined to the cervix or microscopic lesion greater than
T1a/IA2
|
|
T1b1
|
IB1
|
Clinically visible lesion ≤ 4.0 cm in greatest dimension
|
|
T1b2
|
IB2
|
Clinically
visible lesion > 4.0 cm in greatest dimension
|
|
T2
|
II
|
Cervical
carcinoma invades beyond uterus but not to pelvic wall or to lower third of
vagina
|
|
T2a
|
IIA
|
Tumor
without parametrial invasion
|
|
T2a1
|
IIA1
|
Clinically visible lesion ≤ 4.0 cm in greatest dimension
|
|
T2a2
|
IIA2
|
Clinically
visible lesion > 4.0 cm in greatest dimension
|
|
T2b
|
IIB
|
Tumor with
parametrial invasion
|
|
T3
|
III
|
Tumor
extends to pelvic wall and/or involves lower third of vagina and/or causes
hydronephrosis or nonfunctional kidney
|
|
T3a
|
IIIA
|
Tumor
involves lower third of vagina, no extension to pelvic wall
|
|
T3b
|
IIIB
|
Tumor
extends to pelvic wall and/or causes hydronephrosis or nonfunctional kidney
|
|
T4
|
IV
|
Tumor
invades mucosa of bladder or rectum and/or extends beyond true pelvis
(bullous edema is not sufficient to classify a tumor as T4)
|
|
T4a
|
IVA
|
Tumor
invades mucosa of bladder or rectum (bullous edema is not sufficient to
classify a tumor as T4)
|
|
T4b
|
IVB
|
Tumor
extends beyond true pelvis
|
|
Regional lymph nodes (N)
|
|
|
|
NX
|
Regional
lymph nodes cannot be assessed
|
|
|
N0
|
No
regional lymph node metastasis
|
|
|
N1
|
Regional
lymph node metastasis
|
|
|
Distant metastasis (M)
|
|
|
|
M0
|
No distant
metastasis
|
|
|
M1
|
Distant
metastasis (including peritoneal spread; involvement of supraclavicular,
mediastinal, or para-aortic lymph nodes; and lung, liver, or bone)
|
|
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台灣40% 都要 RT
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Hydronephros
when pregnancy is mostly at the right side due to right Ureter angulation
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