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Cervical Cancer
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Georgios Imseeh, Alexandra Taylor
In addition to the morbidity and mortality associated with any major pelvic operation, radical hysterectomy can also cause specific problems in the pelvis. The most common of these is a degree of flaccidity of the bladder. This symptom is apparent soon after surgery and often improves with bladder drainage over a period of a few weeks. Rarely, the bladder remains flaccid, and the patient has to practice intermittent self-catheterization.
Common Tips on Communication
Published in Justin C Konje, Complete Revision Guide for MRCOG Part 3, 2020
This is also called a radical hysterectomy. This is a surgery in which the womb, neck of the womb, the upper part of the vagina and the tissues around the upper part of the vagina and the neck of the womb are removed. It is a surgical treatment for cancer of the cervix. Part of this surgery involves removing the lymph nodes that drain from the cervix to check whether the cancer cells have not spread to them.
Peripheral Neuropathies of the Lower Urinary Tract Following Pelvic Surgery and Radiation Therapy
Published in Jacques Corcos, Gilles Karsenty, Thomas Kessler, David Ginsberg, Essentials of the Adult Neurogenic Bladder, 2020
Lower urinary tract dysfunction is the most common long-term side effect of radical hysterectomy for cervical and uterine malignancy, with rates of 8%–80% depending on the limits of dissection.13–15 Urodynamic evaluation has shown rates of poor compliance, mixed urinary incontinence, and stress urinary incontinence to be present in 35%, 17%, and 38% percent of patients one year following surgery.13 While patients may not develop complete retention, due to a decrease in midurethral closure pressure, patients may exhibit elevated residuals with decreased urinary flow 2–12 weeks following surgery due to parasympathetic injury to the pelvic splanchnic nerve as well as pudendal nerve injury.16 The onset of post-operative stress urinary incontinence in some patients may be related to destruction of bladder neck support, but also to sympathetic nerve injury to the end branches as they leave the inferior hypogastric plexus.13,15 The development of nerve sparing approaches has led to a reduction in post-operative urinary dysfunction; patients who undergo non-nerve sparing radical hysterectomy have an increased odds ratio of 3.4 for developing poor bladder compliance in one study by Oda et al, which is aligned with single center reports.13 Minimally invasive approaches have also showed some promise in allowing greater magnification of pelvic nerves with improved nerve sparing and post-operative voiding function.13
Health-related quality of life for early-stage cervical cancer survivors after primary radical surgery followed by radiotherapy versus radical surgery alone
Published in Journal of Obstetrics and Gynaecology, 2022
Runchida Suvannasarn, Tanarat Muangmool, Nahathai Wongpakaran, Kittipat Charoenkwan
From March 2018 through October 2018, the authors invited women diagnosed with early-stage cervical cancer (FIGO stage IA2-IIA), who had primary radical surgery (radical hysterectomy and pelvic lymphadenectomy) with or without postoperative adjuvant pelvic radiation at our institution to participate. Patients with recurrent disease were excluded. Informed consent was obtained from each participant. All participants were asked to complete the assigned quality of life questionnaires. Their clinical, surgical, and pathological data were also obtained via medical records. All data and scores from the quality of life questionnaires were compared between participants with radical surgery alone (group 1) and those with radical surgery followed by postoperative radiation (group 2). Radical hysterectomy was performed using the type B2 or type C technique according to the Querleu–Morrow classification of radical hysterectomy (Querleu et al. 2017). Adjuvant radiation consisted of external-beam pelvic radiotherapy of 46 Gy in 2 Gy fractions. For patients with high-risk pathological factors (pathological evidence of cancer metastasis to pelvic nodes/parametria or involved surgical margins), concurrent chemotherapy (cisplatin 40 mg/m2 once a week) and brachytherapy to the vaginal vault were also added. This project was approved by the Faculty of Medicine, Research Ethics Committee (approval number OBG-2561-05242) before its commencement.
Mini-Laparoscopy or Single-Site Robotic Surgery in Gynecology? Let’s Think out of the Box
Published in Journal of Investigative Surgery, 2022
Antonio Simone Laganà, Simone Garzon, Maurizio Nicola D’Alterio, Marco Noventa, Guglielmo Stabile, Antoine Naem, Fabio Ghezzi
In gynecology, the minimally invasive approach gained increasing popularity over time for both benign [2] as well as malignant [3] diseases. However, warnings concerning the use of the laparoscopic approach in gynecologic oncology have been raised by the randomized controlled trial of Ramirez et al. [4]. In this study, the authors demonstrated that minimally invasive radical hysterectomy is associated with lower rates of disease-free survival and overall survival than open abdominal radical hysterectomy among women with early-stage cervical cancer. This evidence changed the everyday clinical practice to manage cervical cancer and stressed the need for high-quality evidence before achieving definitive conclusions on the surgical approach in malignant diseases. However, besides this exception and the caution required in malignant pathologies, the use of minimally invasive techniques could be considered the gold standard approach for the management of gynecological diseases that require surgery.
New instrument for measuring quality of life in patients with cervical cancer
Published in Health Care for Women International, 2021
Slobodan Jankovic, Radica Zivkovic Zaric, Katarina Krasic, Valentina Opancina, Nikola Nedovic, Marija Zivkovic Radojevic
The quality of life in patients with cervical cancer is a very important topic. Treatment of these patients altered notably over the last decades. Various types of treatment are used for the different stages of cervical cancer. Patients with a lower grade of the disease typically experience radical hysterectomy. For patients with locally advanced illness, chemotherapy with extensive radiotherapy, together with brachytherapy and outside pelvic irradiation became standard of treatment for several years (Aaronson et al., 1993; Green et al., 2001). When comparing with the validation of questionnaires like QLQ-CX24 and FACT-CX, the mean age of our patients (51.6 years) was similar to the patients included invalidation of QLQ-CX24 (Greimel et al., 2006). In our sample 33% of participants were smokers; approximately all meta-analyses and multi-institutional studies spot that smoking is a significant morbidity cofactor for cervical squamocellular cancer and also for cervical adenocarcinoma (Fonseca-Moutinho, 2011). After testing of QLQ CX24 in our study, its Cronbach's alpha value was >0.70, significantly lower compared to that of our scale 0.971 (Greimel et al., 2006). Even in the original validation study of QLQ-C30 Cronbach's alpha was 0.860, yet lower than that of our questionnaire (Greimel et al., 2006). This perhaps reflects differences in cultural settings of the countries where the scales were originally developed.