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Rivera v. Edmonds9/12/1997
AID BY THE PETITIONERS.
APPENDIX
Excerpts from Drs. S.A. Cannistra & J.M. Niloff, Cancer of the Uterine Cervix, Vol. 334, No. 16 New England Journal of Medicine 1030 (Apr. 18, 1996).
[SEE Figure 3. Algorithm for Managing Pap-Smear Findings Suggestive of an Intraepithelial Lesion. IN ORIGINAL]
[SEE Figure 4. Algorithm for Managing Microinvasive or Invasive Disease. IN ORIGINAL]
Table 1. Staging of Cervical Cancer.*
*Based on the staging system established by the International
Federation of Gynecology and Obstetrics. Staging may be based on
information obtained from a pelvic examination performed while the
patient is under anesthesia, intravenous pyelography, cystoscopy,
and proctoscopy. The stage is determined clinically and does not
change on the basis of findings at the time of surgery.
Stage I: The tumor is confined to the uterus.
IA Microinvasive disease, with the lesion not grossly
visible. +
+ Microinvasive disease is defined as a lesion not exceeding 5 mm
in depth from the basement membrane and no wider than 7 mm. A
recent distinction has been made between stage IA1 (ò 3 mm deep
andò 7 mm wide) and stage IA2 (>3 mm butò 5 mm deep andò 7
mm wide). The Society of Gynecologic Oncologists defines
microinvasive disease as a lesionò 3 mm in depth beneath the
basement membrane, without evidence of involvement of the
lymphovascular space.
IB Larger tumor than in stage IA or grossly visible tumor
confined to the cervix. ++
++ A recent distinction has been made between stage IB1 lesions
(ò 4 cm in diameter) and stage IB2 lesions (>4 cm in diameter).
(Footnotes omitted).
Stage II: The tumor extends beyond the uterus but does not
involve the pelvic side wall or lowest third of the vagina.
IIA Involvement of the upper two thirds of the vagina,
without lateral extension into the parametrium.
IIB Lateral extension into parametrial tissue.
Stage III: The tumor involves the lowest third of the vagina or
the pelvic side wall or causes hydronephrosis.
IIIA Involvement of the lowest third of the vagina.
IIIB Involvement of the pelvic side wall or hydronephrosis.
Stage IV: The tumor demonstrates extensive local infiltration
or has spread to a distant site.
IVA Involvement of bladder or rectal mucosa.
IVB Distant metastasis.
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