Explain：Cervical cancer

Content: RAH + BPLD

Clinical Information:

The patient had {{ abnormal vaginal bleeding, abnormal Pap smear, ASCUS, LSIL, HSIL, Cancer on Pap}}.

Patient underwent a cervical biopsy and microscopic histological showed malignant cervical cancer.

Clinical staging is stage {{Ia2, Ib1, Ib2, Iia}}.

Pelvic and abdominal CT shows retroperitoneal lymph node {{enlarged, not enlarged}}.

The biochemical data are: SCC:_______, CEA:________.

Menopause {{ +, -}}.

Neoadjuvant chemotherapy {{+, -}}.

Radiation history {{+, -}}.

Operative Procedures:

Type of operation: RAH + [[BSO, RSO, LSO, BS, BPLD, APPENDECTOMY, ENTEROLYSIS]].

After meticulous evaluation of the pelvic and abdominal cavity to rule out the possible evidence of metastatic tumor and the intestinal loops were placed in the upper abdominal cavity by gauze pads and the uterus and adnexae were well-exposed. Bilateral round ligaments were severed and double ligated with silk sutures, and both anterior and posterior broad ligaments were dissected over the ovarian ligament posteriorly and to the bladder base anteriorly. The bladder dome was pushed downward by sharp and blunt dissection carefully to expose the cervix and upper vagina wall. The left paravesical and pararectal spaces were developed by blunt dissection.. Dissection of the lymphatic tissue began from the bifurcation of left common iliac artery and extended upward to the bifurcation of the aorta and downward to the lateral and medial inguinal regions. The lymphatic tissue above the common iliac bifurcation was removed en bloc and sent for histologic investigation as upper pelvic nodes. That below the point of bifurcation, which including the external iliac nodes, internal iliac nodes, obturator, medial and lateral inguinal nodes, were also dissected en bloc as lower pelvic nodes. Stepwise dissection of the cardinal ligament was undertaken by several clamping and ligating the vascular cardinal ligament from its attachment at the lateral pelvic side wall. Continuation of this plan of dissection along the posterior endopelvic fascia was undertaken to free the posterior aspect of the cervix from the pelvic floor. The bladder was then dissected further from the upper portion of the vagina by sharp and blunt dissection and the vesicocervical space is developed inferiorly and laterally. The vaginal canal was clamped to avoid spillage of tumor cells into the pelvis and then the upper 3 cm of vagina are removed with surgical specimen. Closure of the vagina cuff by using 1-0 Vicryl was performed. Meticulous normal saline irrigation to wash the blood clot and hemostasis was then performed. Two J-P draining tubes were placed over bilateral pelvic floors.

Operative Findings:

Cervix tumor size: _________CM.

Vagina: {{not invasive, invasive}}

Parametrium: {{not invasive, invasive , fixed to side wall}}

Hydroureter: {{not, yes}}

Section margin of vagina: {{0.5cm 1cm, 2cm, 3cm,}}

Parametrium length: {{0.5cm, 1cm, 2cm, 3cm}}

Lymph node status: [[node not enlarged, R’t pelvic nodes enlarged, L’t node enlarged, paraaortic node not enlarged, Paraaortic node metastasis]]

Complication: [[massive bleeding, ureter injury, bladder injury, intestine injury, _______________]].

Pathology:

Cell type: {{SQUAMOUS CELL CARCINOMA, ADENOCARCINOMA, SMALL CELL CARCINOMA, LELC}}.

Grade: {{1, 2, 3}}

Depth: {{<1/3, 1/2, 2/3, near full thickness, full thickness}}

R’t pelvic nodes: {{ negative, positive _______}}.

L’t pelvic nodes: {{ negative, positive _______}}.

R’t paraaortic nodes: {{ negative, positive _______}}.

R’t paraaortic nodes: {{ negative, positive _______}}.

Parametrium: {{negative, positive}}

Vagina: {{negative, positive}}

Dr:________________. Date: _______________.