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Urologic Involvement
Published in Nazar N. Amso, Saikat Banerjee, Endometriosis, 2022
Jörg Keckstein, Gernot Hudelist, Simon Keckstein
Although ureteroneocystostomy alters the anatomy of the urinary tract, Carmignani's study demonstrated that ureteral resection and ureteroneocystostomy for infiltrating endometriosis have significantly no negative effect on urodynamic parameters (54). However, it is known that after radical removal of the parametrial structures with the parasympathetic and sympathetic nerve fibers running in them, there is a great risk of postoperative bladder dysfunction (2,54).
Cervical Cancer
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Georgios Imseeh, Alexandra Taylor
The treatment of invasive cervical cancer depends on the stage of disease, tumor size, lymph node status, and the fitness of the patient.29 It can incorporate surgery, radiotherapy, and chemotherapy. Ideally, a single definitive modality should be used, as there is no survival advantage and far greater morbidity with a combined surgical and radiotherapy approach. Although surgery is preferable for early-stage disease, radiotherapy is the treatment of choice when there is parametrial or nodal involvement, which emphasizes the need for optimal imaging to stage the disease at presentation.30,31
Endometrial malignant lesions
Published in T. Yee Khong, Annie N. Y. Cheung, Wenxin Zheng, Richard Wing-Cheuk Wong, Hao Chen, Diagnostic Endometrial Pathology, 2019
T. Yee Khong, Annie N. Y. Cheung, Wenxin Zheng
Parametrial invasion has been shown to be another poor prognostic factor.43 Parametrial tissue is not resected in the surgeries for the majority of endometrial cancers, except where the cancer involves the cervix when radical hysterectomy is performed. When this happens, parametria are assessed just like endocervical cancer.
Optimal treatment in locally advanced cervical cancer
Published in Expert Review of Anticancer Therapy, 2021
Christine Gennigens, Marjolein De Cuypere, Johanne Hermesse, Frédéric Kridelka, Guy Jerusalem
Gynecologic examination with colposcopy-guided biopsy and pelvic magnetic resonance imaging (MRI) are mandatory for primary tumor ‘T’ staging [27]. Thomeer et al. [28] published a meta-analysis comparing the diagnostic performances of clinical examination and MRI in detecting parametrial invasion and advanced stage (FIGO stage ≥ IIB). For the evaluation of parametrial invasion/advanced disease, sensitivity was 40%/53% and 84%/79% with clinical examination and MRI, respectively, clearly in favor of MRI [28]. Knoth et al. [29] demonstrated 27% of discrepancies between MRI and clinical gynecologic examination. With MRI, upstaging is more frequent than downstaging. Tumor size and parametrial infiltration seemed to be more correctly assessed with MRI. Vaginal and pelvic side wall infiltrations were more precisely evaluated by gynecologic examination [29].
Pulmonary recurrence after radical hysterectomy for uterine cervical carcinoma
Published in Journal of Obstetrics and Gynaecology, 2020
Cigdem Kilic, Dilek Yuksel, Caner Cakir, Alper Karalok, Gokhan Boyraz, Ozlem Moraloglu Tekin, Taner Turan
The mean age of patients with PR was 53.7 years and ranged between 27 and 73 years. The median tumour size was 40 mm (ranged 20–72 mm) and median number of metastatic lymph node count was four and ranged between one and 19. The tumour type was squamous cell carcinoma (SCC) in 12 (70.6%) patients and adenocarcinoma in five (29.4%). Eleven (64.7%) patients were stage IB1, four (23.5%) were stage IB2 and two were stage IIA1 (11.8%) according to FIGO 2014 criteria. The tumour size was ≥20 mm–<40 mm in seven (41.2%) patients and ≥40 mm in ten (58.8%). Median number of removed lymph nodes was 47 and ranged between 22 and 88. Eleven (64.7%) patients had lymph node metastasis. Patients with metastatic lymph nodes in only pelvic region was nine (81.8%), in only para-aortic region was one (9.1%) and in both pelvic and para-aortic regions was one (9.1%). Parametrial invasion was positive in six (35.3%) patients. LVSI was positive in 12 (70.6%) patients, vaginal invasion was positive in four (23.5%) patients and two (11.8%) patients had positive surgical border. Uterine invasion was detected in four (23.5%) patients and deep stromal invasion was detected in 15 (88.2%). Sixteen patients (94.1%) didn’t receive neoadjuvant chemotherapy. Bilateral salpingo-oophorectomy had not been performed in only one patient (5.9%). Data related to clinical and surgico-pathological factors were summarised in Table 1 and Table 2.
A retrospective analysis of the effect of planning tumour volume on survival in cervical carcinoma
Published in Southern African Journal of Gynaecological Oncology, 2018
Tumour size has generally been determined by pelvic examination. This in itself can be problematic. Clinical examination is not very reliable and understandably differs between observers. The limitations to clinical staging are especially apparent in advanced disease. A more precise and objective method, such as CT or MRI, is preferable.7 Walsh et al. demonstrated that even the use of CT is not entirely accurate in determining tumour volume, as this modality does not provide adequate evaluation of parametrial involvement. This is due to low soft tissue contrast resolution. MRI on the other hand is an imaging method that has several benefits, including improved soft tissue contrast (leading to accurate tumour size measurement and assessment of surrounding soft tissue invasion), improved assessment of depth of stromal invasion and lymph node evaluation.8 Due to resource limitations no advanced stage patient was imaged with either CT or MRI in our institution during the study period.