Cervical vs Endometrial

[thomascarpenter]

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Please help with this case:

65yo WF with bulky bleeding cervical mass as well as uterine mass that were both biopsied and came back as adenoCA. Pathologist read it as cervical origin. PET scan was done that showed PET avid adnexal masses suspicious for met.

So the patient was staged as IB2 cervical cancer and deemed not a surgical candidate due to bulky cervical mass. She was started concurrent chemoRT and now getting T and O. I am now going thru the chart for the first time and I am wondering whether this is endometrial to begin with. I guess the question is whether you ever see adnexal involvement with cervical cancer (more complicated by the fact that this is adenocA) and whether you would do anything differently with this patient now that she has had almost 75 Gy to point A, possibly hysterectomy at this point would be feasible?

 

[Palex80]

I am kind of confused...

Why is stage IB2 if the patient has involvement of the adnexes?
Isn't this at least IIB by direct extension of the cervical tumor into the adnexes (parametrial invasion)?

 

[deleted4401]

Sounds like adnexal mets seen on PET-CT that were non-contiguous, so it was FIGO IB2**, but probably will behave like a "stage IV". Were the mets treated in the pelvic fields (I presume they at least got 45 Gy with a typical 4 field pelvis with the old field borders). Is there a way to boost them safely? Otherwise, MRH + BSO, post op? Increased risk of complications, but I don't know what else you can do. 45 Gy/Chemo isn't enough for gross disease...

**This is the most inane staging system I've ever seen. I get the idea of "comparable" staging, but why tie your hands behind your back? I mean, there is now more lung cancer in China and India, but that doesn't mean we should stage using physical exam and CXR. There should be a FIGO stage, and a "true" stage. If a PET-CT showed a cervical LN, I don't know if I should be treating as a IB2.

 

[Palex80]

Indeed, crazy stuff

 

[Reaganite]

Please help with this case:

65yo WF with bulky bleeding cervical mass as well as uterine mass that were both biopsied and came back as adenoCA. Pathologist read it as cervical origin. PET scan was done that showed PET avid adnexal masses suspicious for met.

So the patient was staged as IB2 cervical cancer and deemed not a surgical candidate due to bulky cervical mass. She was started concurrent chemoRT and now getting T and O. I am now going thru the chart for the first time and I am wondering whether this is endometrial to begin with. I guess the question is whether you ever see adnexal involvement with cervical cancer (more complicated by the fact that this is adenocA) and whether you would do anything differently with this patient now that she has had almost 75 Gy to point A, possibly hysterectomy at this point would be feasible?

Typically, cervix involvement by endometrial cancer isn't bulky as you describe, but I suppose there are always exceptions, particularly if a patient delays visiting a physician.

Did patient have pelvic MRI? This can sometimes help distinguish between the two based on the "center of mass." If there's a big cervical mass with minimal endometrial extension, you'd figure cervix origin. Conversely, if there's a big mass centered in the uterus, and minimal cervix involvement, you'd be thinking more endometrium.

Regarding the PET avid masses, I've seen cases like this where patient ended up having a synchronous ovarian primary rather than an adnexal met.