CT Evaluation of Cervical Cancer: Spectrum of Disease

Abstract

Invasive cervical cancer is the third most common gynecologic malignancy. The prognosis is based on the stage, size, and histologic grade of the primary tumor and the status of the lymph nodes. Assessment of the stage of disease is important in determining whether the patient may benefit from surgery or will receive radiation therapy. The official clinical staging system of the International Federation of Gynecology and Obstetrics has led to errors of 65%-90% in stage III and IV disease; the result has been unofficial extended staging with cross-sectional imaging modalities such as computed tomography (CT). CT is useful in staging advanced disease and in monitoring patients for recurrence. The primary tumor is heterogeneous and hypoattenuating relative to normal stroma on contrast material-enhanced scans. Obliteration of the periureteral fat plane and a soft-tissue mass are the most reliable signs of parametrial extension. Less than 3 mm separation of the tumor from the pelvic muscles and vascular encasement are signs of pelvic side wall invasion. Lymphatic spread is along the external and internal iliac nodal chains and the presacral route to the paraaortic nodes. Distant metastases are seen with primary or recurrent disease and can involve the liver, lung, and bone.

Recurrent Cervical Cancer: How Can Radiology be Helpfull

“…The response may be immediate (3-6 months) or, in larger tumors, delayed (6-9 months) [15]. Hricak et al reviewed the MR images of 69 patients submitted to radiotherapy to cervical cancer and reported that the reconstitution of the normal zonal anatomy of the cervix and homogeneous cervical low signal have high negative predictive value (97%) for recurrence [14].…”

“…Adrenal metastases are usually from cervical adenocarcinomas and are present in approximately 15% of patients. Peritoneal metastases appear as soft-tissue masses and ascites and are present in 5%-27% of cases in autopsy series (Figure 14) [15,28].…”

“…Lymphangitic carcinomatosis is seen in less than 5% of patients and appears as diffuse interstitial lung disease [25]. Mediastinal or hilar adenopathy and pleural lesions or effusions are present in approximately onethird of patients with metastatic disease to the chest [15].…”

A Case of Metastatic Lymph Node of Invasive Cervical Cancer Diagnosed by Endoscopic Ultrasonography-Guided Fine Needle Aspiration Biopsy

“…1,2 Prognoses of cervical cancer are based on the stage, size, histologic grade of a primary tumor and metastasis of lymph node. 3 Most of metastasis begins in the surround lymph node, and common distant metastatic sites of cervical cancer are lung, gastrointestinal tract, bone, and liver. 3 Distant metastases can be rarely developed in skin and central nervous system.…”

“…3 Most of metastasis begins in the surround lymph node, and common distant metastatic sites of cervical cancer are lung, gastrointestinal tract, bone, and liver. 3 Distant metastases can be rarely developed in skin and central nervous system. 4,5 CT and MRI are useful in staging advanced disease and in monitoring patients for recurrence of the disease.…”