Significance of Grading in Urological Abnormalities in Carcinoma Cervix and its impact on Overall Survival

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Significance of Grading in Urological Abnormalities in Carcinoma Cervix and its impact on Overall Survival

Journal Title: Journal of Advanced Medical and Dental Sciences Research - Year 2017, Vol 5, Issue 11

Abstract

Introduction: Cervical cancer is the second most common gynaecological malignancy and notorious for causing urological manifestations in about 20-40% cases. Various abnormalities observed are either due to the local mass effect caused by the disease, from metastatic nodes or due to direct infiltration of urinary bladder. Materials &Methods: A retrospective analysis was made of cervical carcinoma cases that were staged and graded on the basis of urological abnormalities using different imaging modalities. An inherent grading system was used to evaluate the urological abnormalities. Outcome was determined in terms of overall survival and quality of life benefits. Results: Out of 381 patients enrolled in the study, 284(74.5%) patients were grade 0 followed by 35(9.1%) patients who were grade II. Patients suffering from grade II and III urological abnormalities were offered surgical intervention, however, only 27(50%) patients could undergo surgery due to either medical or monitory reasons. The most common urological intervention done were stenting (unilateral or bilateral) in 18(3.4%) patients followed by percutanous nephrostomy (PCN unilateral or bilateral) in 7(12.9%) patients and only 2 patients underwent radical procedures like anterior resection and illeal conduit. The majority of interventions 17(62.9%) were done in grade II patients. External beam radiotherapy with pelvic field and extended field followed by ICRA was given wherever indicated. All patients were followed for a period of 18 months. Reversal of urological abnormalities was seen in 7% patients, and all of them were in grade II category. On scrutinizing, the majority of grade II abnormalities 30(63.8%) were observed in stage II disease patients. At the end of 18 months follow up, 60.6% patients of grade 0 disease and 68.6% patients in grade I were disease free, whereas (70%) patients of grade II and (21.2%) patients in grade III were disease free at the end of follow up. Conclusion: Grading of urological abnormalities serves as a useful prognostic tool to determine the outcome in carcinoma cervix. However, it is imperative that the cases with reversible hydronephrosis should be identified at an early stage and intervention should be done at an early step. Reversible hydronephrosis during treatment is a significant prognostic factor associated with good performance status and better outcome in terms of overall survival.

Authors and Affiliations

Marcus S, Mahajan MK, Patil J

Keywords

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