A patient with a family history of gynecological cancer presents with concerns about her risk of developing one and various diagnostic strategies. Which of the following gynecological cancers is most likely to be staged clinically rather than surgically?
Cervical cancer is the only gynecological cancer that is clinically staged. Clinical staging involves predicting the amount of invasion into adjacent structures and metastatic involvement. Diagnostic tools include exam under anesthesia, chest X-ray, cystoscopy, proctoscopy, intravenous pyelogram, and barium enema. MRI and CT can be used to define the extent of the disease but not to determine the stage. Intraoperate findings or disease progression does not alter stage assignment.
Endometrial cancer (Choice B) is surgically staged with total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAHBSO) as it relies on pathologic confirmation. During surgery, the uterus should be opened to determine the depth of myometrial invasion. Most endometrial cancers are diagnosed at stage I.
Ovarian cancer (Choice C) is surgically staged using TAHBSO, omentectomy, peritoneal washing and cytology, Pap smear of the diaphragm, and sampling of pelvic and para-aortic lymph nodes. Nearly 75% of patients present with stage III or IV cancers.
Vaginal cancer (Choice D) is surgically staged based on tumor size and invasiveness, nodal involvement, and distant metastases. The most important prognostic factor is the number of positive inguinal lymph nodes.
Vulvar cancer (Choice E) is surgically staged similarly to vaginal cancer.