Routine pretreatment evaluation of patients with gynecologic cancer

We evaluated the usefulness of the routine pretreatment performance of a chest x-ray, intravenous pyelogram (IVP), cystoscopy, barium enema, and sigmoidoscopy in patients presenting with endometrial and cervical carcinoma by reviewing the results of these tests in 231 patients. In no patient with cervical or endometrial carcinoma was tumor involvement of the large bowel mucosa found by the use of sigmoidoscopy and barium enema. Two percent of the cervical patients and none of the endometrial patients had bladder mucosal involvement discovered by using cystoscopy. Ureteral obstruction was seen by the IVP in 9% of the cervical patients and 1% of the endometrial patients. All of the women with cervical carcinoma who had bladder mucosal invasion or ureteral obstruction were already stage III before these tests. The chest x-rays showed a 0.7 and 3% incidence of tumor involvement in cervical and endometrial patients, respectively. The final stage differed from the initial stage in seven of the cervical patients and in two of the endometrial patients, but only in three of these nine were the changes based on the findings of the routine pretreatment evaluation. We conclude that routine cystoscopy, barium enema, and sigmoidoscopy in all patients with early stage cervical or endometrial carcinoma is not necessary, that a routine chest x-ray is still indicated in all patients with these malignancies, and that IVP should be performed routinely in all patients with cervical carcinoma but only if clinically indicated in patients with endometrial carcinoma.