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Table of Contents
LETTERS TO EDITOR
Year : 2021  |  Volume : 4  |  Issue : 1  |  Page : 190-191

COVID-related increase in pelvic and para-aortic lymphadenopathy in patients with cervical cancer


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 Submission15-Feb-2021
Date of Decision22-Feb-2021
Date of Acceptance23-Feb-2021
Date of Web Publication26-Mar-2021

Correspondence Address:
S P Somashekhar
Manipal Comprehensive Cancer Center, Manipal Hospital, Bengaluru, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/crst.crst_40_21

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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 22];4:190-1. Available from: https://www.crstonline.com/text.asp?2021/4/1/190/312102



Selvaraj and Gudipudi[1] 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.[2],[3],[4] 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.[5]

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.[6]

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.[7]

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.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Selvaraj VK, Gudipudi DK. Surge in pelvic and para-aortic nodal involvement in newly diagnosed cervical cancer patients during coronavirus disease 2019: A chance or imminent reality? Cancer Res Stat Treat 2020;3:829-30.  Back to cited text no. 1
  [Full text]  
2.
Uwins C, Bhandoria GP, Shylasree TS, Butler-Manuel S, Ellis P, Chatterjee J, et al. COVID-19 and gynecological cancer: A review of the published guidelines. Int J Gynecol Cancer 2020;30:1424-33.  Back to cited text no. 2
    
3.
Dessai S, Nachankar A, Kataria P, Abyankar A. Management of patients with gynecological cancers during the COVID-19 pandemic. Cancer Res Stat Treat 2020;3 Suppl S1:40-8.  Back to cited text no. 3
    
4.
Goel A. Management of cancer during the COVID pandemic: Treatment of gynecological malignancies. Cancer Res Stat Treat 2020;3 Suppl S1:106-9.  Back to cited text no. 4
    
5.
Mathur P, Sathishkumar K, Chaturvedi M, Das P, Sudarshan KL, Santhappan S, et al. Cancer statistics, 2020: Report from national cancer registry programme, India. JCO Glob Oncol 2020;6:1063-75.  Back to cited text no. 5
    
6.
Chen CP, Kung PT, Wang YH, Tsai WC. Effect of time interval from diagnosis to treatment for cervical cancer on survival: A nationwide cohort study. PLoS One 2019;14:e0221946.  Back to cited text no. 6
    
7.
Marnitz S, Tsunoda AT, Martus P, Vieira M, Affonso Junior RJ, Nunes J, et al. Surgical versus clinical staging prior to primary chemoradiation in patients with cervical cancer FIGO stages IIB-IVA: Oncologic results of a prospective randomized international multicenter (Uterus-11) intergroup study. Int J Gynecol Cancer 2020;30:1855-61.  Back to cited text no. 7
    




 

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