Question

A 50-year-old woman presents with foul-smelling bloody discharge per vagina mixed with mucous. On examination, a necrotizing growth is seen in the cervix with lateral parametrium involvement. What is the management for this patient?

• A. Chemotherapy
• B. Brachytherapy
• C. Chemoradiation
• D. Surgery

Answer 1

The Correct Option is C

A 50-year-old woman presents with symptoms and clinical findings indicative of advanced cervical cancer, including foul-smelling bloody discharge and a necrotizing growth involving the cervix and parametrium. In determining the management plan, it is essential to consider the extent of disease involvement. The presence of lateral parametrium involvement suggests the cancer is at least stage IIB according to the FIGO staging system for cervical cancer. At this stage, the recommended treatment is typically chemoradiation.

Here's the rationale for the management selection:

• Chemotherapy alone is generally not sufficient for locally advanced cervical cancer. It might be used in cases of metastatic disease or as palliative care.
• Brachytherapy is used in conjunction with external beam radiation for localized treatment. However, when the disease involves the parametrium, like in this case, brachytherapy alone is inadequate.
• Chemoradiation is the standard care for stage IIB or greater cervical cancer. It involves a combination of chemotherapy (usually cisplatin) with radiation therapy to enhance the effects of radiation and improve local control.
• Surgery is predominantly used in early-stage cervical cancer, where radical hysterectomy can be performed. In advanced cases with parametrium involvement, surgery is not feasible due to increased risk of surgical complications and inadequate oncological results.

Therefore, for this patient with involvement of the cervix and parametrium, chemoradiation is the most appropriate management option, combining systemic treatment with localized radiation to treat both visible and microscopic disease.