This study compared clinical examination to examination under anesthesia (EUA) for staging locally advanced cervical cancer in 62 patients. There was significant variation between the two methods. Upstaging occurred in 14 patients and downstaging in 12 patients after EUA. Staging changed in 26 patients overall. Parametrial assessment showed the highest discordance. EUA is recommended for staging, especially for parametrial assessment, as it reduces bias and variability compared to clinical examination alone. The authors conclude that EUA or other objective staging methods should be considered mandatory for accurate staging of locally advanced cervical cancer in India given its high prevalence.

1. COMPARISION OF CLINICAL EXAMINATION VERSUS
EXAMINATION UNDER ANAESTHESIA IN
LOCOREGIONALLY ADVANCED CARCINOMA CERVIX-
SINGLE INSTITUTIONAL REPORT
Prof.Dr.R.Rajaraman.,M.Ch
Prof.Dr.S.Subbiah.,M.Ch
Dr.A.Joseph Stalin AntonyMuthu-M.Ch(PG)
Centre for Oncology
Govt Royapettah Hospital,Chennai.

2. Why this study?
• Magnitude of problem in India
• Carcinoma Cervix staged clinically.
• High chance for bias and intra/interobserver
variation.
• Any bias in clinical examination can alter stage,
treatment modality, prognosis,
statistics,research work.

3. OBJECTIVE
• Aim is to determine the variance in clinical
staging.
• By comparing clinical examination versus
examination under anaesthesia in
locaregionally advanced carcinoma cervix.

4. METHODOLOGY
• Study Design : Prospective comparitive study.
• Place :Govt.Royapettah Hospital, Chennai.
• Period : Aug,2013-Aug,2014.
• No of patients: 62

5. METHODOLOGY
• Selection Criteria: carcinoma cervix patients-
clinically staged-IB2,II,III,IVA – planned for
EUA.
• Study population : Low socioeconomic strata.
Mean age :50.5 yrs.(36-64)
• Data analysis done using Chisquare/Fisher’s
exact test.

6. PARAMETERS COMPARED
Clinical Vs EUA
• Size of tumour
• Vaginal involvement
• Parametrial involvement
• FIGO Stage

7. CLINICAL STAGE
• N = 62
• IB2 = 20
• IIA2 = 08
• IIB = 34
CLINICAL STAGE
IB2
IIA2
IIB

8. IB2 POST EUA
IB2
IB2
IIA2
IIB
• Clinical IB2 = 20
Post EUA
• IB2 = 12
P =0.001
• IIA2 =02
• IIB = 06

9. IIA2 POST EUA
IIA2
IIA2
IIB
• Clinical IIA2 = 08
Post EUA
• IIA2=06 P=0.0357
• IIB = 02

10. IIB POST EUA
IIB
IIB
IBI
IB2
IIA1
IIA2
IIIB
• Clinical IIB = 34
Post EUA
• IIB = 18
• IB1 = 01
P=0.0001
• IB2 = 06
• IIA1 = 02
• IIA2 = 03
• IIIB = 04

11. RESULTS
• Upstaging noted in 14 patients
• Downstaging noted in 12 patients.
• Variation in clinical finding without alteration of stage seen
in 14 patients
• Discordance between clinical and EUA seen in 40
patients(P<0.0001), highest in parametrial assessment.
• Stage migration seen in 26 patients (p=0.0001)
• Treatment modality changed from radiotherapy to surgery
in 3 patients.

12. DISCUSSION
• Is FIGO staging relying only on clinical
examination for staging purpose a standard?
• Pitfalls in FIGO staging –carcinoma cervix
Intra/inter observer variation
Need for barium enema,IVP ?
Paraaortic node ,pelvic node ?

13. CONCLUSION
• EUA recommended for staging carcinoma
cervix especially for parametrial assesment
• Time to consider EUA/IMAGING/SURGICAL
STAGING as prerequisite for staging ?

14. CONCLUSION
• Locoregionally advanced carcinoma cervix –
problem of India( Death due to carcinoma cervix
equals maternal deaths/year)- Indian guidelines
for staging/treatment protocol through RCT need
of the hour.
thank u………..

15. IV B