1. Staging Procedures:

ø Colposcopy of the invasive lesions:

1). Abnormal blood vessels:

• Looped vessels: most common arising from the punctation and mosaic vessels present in cervical intraepithelial neoplasia (CIN)
• Branching vessels: arising from the cervical stroma
• Reticular vessels: the terminal capillaries of the cervical epithelium

2). Irregular surface contour:

• As a result of epithelium ulceration or papillary characteristic of the lesion

3). Color tone change:

• Attributed to increasing vascularity, surface epithelial necrosis, and production of keratin

1. FIGO Staging of Cervical Carcinoma:

　

Stage 0	Carcinoma in situ, intraepithelial carcinoma
Stage I	The carcinoma is strictly confined to the cervix (extension to the corpus should be disregarded)
Stage Ia	Invasive cancer identified only microscopically; all gross lesions even the superficial invasion are stage Ib cancers. Invasion is limited to measured stromal invasion with maximum depth of 5.0 mm and no wider than 7.0 mm
Stage Ia1	Measured invasion of stroma no greater than 3.0 mm in depth and no wider than 7.0 mm.
Stage Ia2	Measured invasion of stroma greater than 3 mm and no greater than 5 mm and no wider than 7 mm. The depth of invasion should not be more than 5 mm taken from the base of the epithelium, surface or glandular, from which it originates. Vascular space involvement, venous or lymphatic, should not alter the staging.
Stage Ib	Clinical lesion confined to the cervix or preclinical lesion greater than stage Ia.
Stage Ib1	Clinical lesions no greaten than 4.0 cm in size
Stage Ib2	Clinical lesions greater than 4 cm in size
Stage II	Involvement of the vagina but not the lower third, or infiltration of the parametria but not out to the sidewall.
Stage IIa	Involvement of the vagina but no evidence of parametrial involvement
Stage IIb	Infiltration of the parametria but not out to the sidewall
Stage III	Involvement of the lower third of the vagina or extension to the pelvic sidewall; all cases with a hydronephrosis or nonfunctioning kidney should be included, unless they are know to be attributable to other cause
Stage IIIa	Involvement of the lower third of the vagina but not out to the pelvic sidewall if the parametria are involved
Stage IIIb	Extension onto the pelvic sidewall and/or hydronephrosis or nonfunctional kidney
Stage IV	Extension outside the reproductive tract
Stage IVa	Involvement of the mucosa of the bladder or rectum
Stage IVb	Distant metastasis or disease outside the true pelvis

　

2. Treatment:

s Surgical Therapy:

¹ Stage Ia1: lesions with invasion less then 3 mm in depth (o )

• If no lymph vascular space invasion:

j extrafascial hysterectomy with pelvic node dissection, or

k modified radical hysterectomy with pelvic node dissection

¹ Stage Ia2: lesions with invasion between 3-5 mm in depth (o )

– Modified radical hysterectomy with pelvic node dissection

¹ Stage Ib/IIa:

– Radical hysterectomy, pelvic lymphadenectomy, and para-aortic lymph node evaluation

ø Types of Hysterectomy:

　

Type I	Extrafascial Hysterectomy
Type II	Modified Radical Hysterectomy	Medial 1/2 of the cardinal ligament and uterosacral ligament
Type III	Radical Hysterectomy	Most of the cardinal ligaments and uterosacral ligament Upper 1/3 of the vagina
Type IV	Extended Radical Hysterectomy	Most of the cardinal ligaments and uterosacral ligament Up to 3/4 of the vagina Periureteral tissue Superior vesicle artery
Type V	Partial Exenteration	Most of the cardinal ligaments and uterosacral ligament Up to 3/4 of the vagina Portions of the distal ureter and bladder

s Radiation Therapy: