Pelvic, paraaortic lymph node involvement common in stage IIIB cervical carcinoma
In patients with cervical carcinoma, lymph node enlargement appears to be common in those with a small cell pathology, while having a stage III disease may lead to involvement of the paraaortic lymph nodes, according to a recent study presented at the recently concluded 2018 World Congress of the Royal College of Obstetricians and Gynaecologists (RCOG 2018) held in Singapore.
The researchers performed a cross-sectional analytical study on 115 cervical carcinoma patients (median age 56 [35–76] years). Ultrasonography and computed tomography (CT) scans were performed to evaluate lymph node involvement and enlargement.
Majority of the included patients had stage III disease (n=80; 40 with stage IIIA and 40 with stage IIIB), while 13.04 percent (n=15) and 18.26 percent (n=21) had stage IIA and IIB disease, respectively. Lymph node involvement was reported across all disease stages. [RCOG 2018, abstract 5826]
The group with stage IIIB cervical cancer had the highest proportion of patients positive for pelvic lymph node involvement, which was detected in 37.5 percent (n=15). This was followed by patients with stage IIB (33.33 percent; n=7) and IIA (26.66 percent; n=4) disease. Involvement of the pelvic lymph node was least frequent in patients with stage IIIA cervical cancer (22.5 percent; n=9).
Enlargement of the paraaortic lymph node was likewise most common in the participants with stage IIIB cervical cancer, of whom 32.5 percent (n=13) were positive for involvement. Corresponding rates of involvement in the stage IIIA and IIB groups were almost identical, at 15 percent and 14.28 percent, respectively.
None of the patients with stage IIA cervical cancer were positive for paraaortic lymph node enlargement.
In terms of histological type, 27.5 percent of patients with large-cell nonkeratinizing cervical cancer were positive for lymph node involvement, according to the authors. In comparison, 31.5 percent of patients with large-cell and 41 percent of patients with small-cell keratinizing cervical cancer had either or both paraaortic and pelvic lymph node involvement.
“In our study, majority of patients with small cell carcinoma of the cervix had either pelvic or paraaortic lymphadenopathy,” said researchers. “Therefore, after histopathologic diagnosis of small cell carcinoma, these patients should be carefully evaluated for the presence of pelvic or paraaortic lymph node metastasis. This can lead to changes in the radiotherapeutic treatment plan.”
For future studies, the researchers suggest that the effects of including the paraaortic and pelvic lymph nodes in the radiotherapeutic regimen of cervical carcinoma patients should be evaluated.
“It appears quite rational to consider the radiation of paraaortic lymph nodes in patients with small cell variety particularly when [the] patient present[s with] stage III [disease],” they noted.