Analysis of Pelvic Lymph Nodal Metastasis in Operable Cases of Cancer Cervix-A One Year Cohort Study at a Regional Cancer Centre

Abstract

Objective: To study the incidence of nodal metastasis in early stage operable cases of  cancer cervix and to correlate the nodal metastasis with different parameters like stage, degree of differentiation, lympho-vascular space invasion (LVSI) and deep stromal invasion. Materials and Methods: This is an observational study conducted in Department of Gynec Oncology, Acharya Harihar Regional Cancer Centre & SCB Medical College, Cuttack. from September 2013 to August 2014. The incidence of Lymph node positivity, Degree of differentiation, Deep Stromal invasion and Lymphovascular space invasion (LVSI) were analysed in 80 patients who underwent Wertheim’s Radical hysterectomy for early stage operable cancer cervix which includes stage I A to II A. Results: The mean age of patients with early stage Cervical cancer was 52.5 years. Post menopausal bleeding was the most common clinical presentation. 17.5% patients had lympho-vascular invasion and pelvic lymph node involvement where as 20% had stromal invasion. None of the patients had vaginal margin involvement. Majority of cases belonged to Stage I B (57.5%), followed by Stage II A (40%) and only 2.5% had Stage I A. Most of the cases (85%) were reported to have squamous cell carcinoma on histopathological examination. Discussion: Patients with Lymph node postivity, positive vaginal margin, parametrial positivity                (1 out of 3 high risk factors) received chemo-radiation. Patients with lesion size more than 4 cm, LVSI, Deep stromal invasion (2 out of 3 intermediate risk factors) received radiation only as per all international protocols. Conclusion: The incidence of lymph node metastasis in cancer cervix patients is quiet significant mostly found in stage IB2, IIA2 but found to be less in stage I A. We are of opinion that Wertheim’s  Radical hysterectomy along with bilateral pelvic lymphadenectomy is an effective mode of treatment in patient with early stage cancer cervix which is required for risk stratification as per post operative histopathological analysis to decide adjuvant therapy in form of Radiotherapy alone or combination of Radiation and Chemotherapy for the better survival rate of patients.