|LETTERS TO EDITOR
|Year : 2021 | Volume
| Issue : 1 | Page : 190-191
COVID-related increase in pelvic and para-aortic lymphadenopathy in patients with cervical cancer
Vijay Ahuja1, Geetu Bhandoria2, SP Somashekhar1
1 Manipal Comprehensive Cancer Center, Manipal Hospital, Bengaluru, Karnataka, India
2 Department of Gyn-Oncology and Obstetrics, Command Hospital, Kolkata, West Bengal, India
|Date of Submission||15-Feb-2021|
|Date of Decision||22-Feb-2021|
|Date of Acceptance||23-Feb-2021|
|Date of Web Publication||26-Mar-2021|
S P Somashekhar
Manipal Comprehensive Cancer Center, Manipal Hospital, Bengaluru, Karnataka
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Ahuja V, Bhandoria G, Somashekhar S P. COVID-related increase in pelvic and para-aortic lymphadenopathy in patients with cervical cancer. Cancer Res Stat Treat 2021;4:190-1
|How to cite this URL:|
Ahuja V, Bhandoria G, Somashekhar S P. COVID-related increase in pelvic and para-aortic lymphadenopathy in patients with cervical cancer. Cancer Res Stat Treat [serial online] 2021 [cited 2021 Apr 23];4:190-1. Available from: https://www.crstonline.com/text.asp?2021/4/1/190/312102
Selvaraj and Gudipudi have presented an interesting perspective on the impact of the coronavirus disease 2019 (COVID-19) pandemic on the presentation of patients with cervical cancer at their center. Undoubtedly, the pandemic has caused major disruptions in the delivery of cancer care. However, most of the treating specialties and centers came up with specific guidelines for cancer management during the pandemic to minimize its impact on cancer care.,, Despite all these measures, cancer care suffered during the initial months of the pandemic but gradually improved over a period of time. Although the authors have presented their concerns equitably, certain inferences appear inaccurate. The authors have mentioned that the involvement of the regional lymph nodes is not as commonly reported as local spread. This is because, according to the Indian National Cancer Registry data, all such cases are grouped together under the advanced disease/locoregional spread category. Such cases account for 60% of all cases of cervical cancer.
Another concern is the period of observation selected by the authors as there is a likelihood of an overlap between the observation periods of the two groups. The reduction in the footfalls has been correctly attributed to the logistical problems due to the complete lockdown enforced by the government. However, this cannot be implicated as the reason for an increase in the incidence of lymph node involvement. A more plausible reason would be that patients with more severe symptoms had more advanced disease and were therefore more likely to visit the hospitals in these difficult times. A difference of a few months in presentation is unlikely to significantly change the extent of the disease at presentation. It has also been shown in various studies that a delay of up to 90 days in initiating treatment may not have a major impact on the survival.
The authors have stated that increased pelvic and para-aortic lymph node spread in the newly diagnosed cases of cervical cancer could also be attributed to chance, and a positive aspect of it would be the effective detection of lymph nodal disease with a magnetic resonance imaging (MRI). However, this statement is somewhat vague and misleading. Ideally, all patients with cancers of the cervix should undergo appropriate imaging to define the extent of the disease before planning the treatment. The latest FIGO staging for cancers of the cervix also includes imaging parameters. Furthermore, the authors have recommended surgical staging for lymph node involvement only if MRI, positron emission tomography, or computed tomography is not available. A recent randomized trial (Uterus-11) comparing these imaging modalities with surgical staging has shown superiority of surgical staging. However, surgical staging involves para-aortic lymph node dissection rather than lymph node sampling.
In addition, the authors have recommended that disease staging and designing radiation treatment fields based on the clinical or ultrasound findings alone should be avoided during and immediately after the COVID-19 era to prevent the mismanagement of newly diagnosed patients with cervical cancer. Although this is appropriate, in certain cases, it may require referral to other treatment centers. However, in case of prolongation of the pandemic with resultant logistic problems, it may be worthwhile to treat the patients with the available resources because in cervical cancer, local control is a major determinant of the quality of life.
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Conflicts of interest
There are no conflicts of interest.
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