Cervical Carcinoma

General characteristics

Cervical carcinoma is the third most common gynecological malignancy (Jemal et al. 2007).

Prognosis

Five-year survival rates vary between 92% for stage I disease and 17% for stage IV disease (Jemal et al. 2007).

Established risk factors for cervical cancer include early sexual activity, especially with multiple partners, cigarette smoking, immunosuppression, and infection with human papilloma viruses 16 and 18. Abnormal uterine bleeding, especially after intercourse, and vaginal discharge may be symptoms leading to the diagnosis.

Diagnosis

MRI is the best single imaging investigation and can accurately determine tumor location (exophytic or endocervical), tumor size, depth of stromal invasion and extension into the lower uterine segment (Nicolet et al. 2000; Okamoto et al. 2003). On T1-weighted images, tumors are usually isointense with the normal cervix, and may not be visible. On T2-weighted images, cervical cancer appears as a relatively hyperintense mass and is easily distinguishable from low signal intensity cervical stroma.

Staging

Stage I tumors are confined to the uterus. Stage IA is defined as a microinvasive tumor that cannot be demonstrated at MRI. Stage IB carcinoma appears as a high-signal- intensity mass in contrast to the low-signal-intensity fibrocervical stroma on T2-weighted images.

Stage II. In stage IIA tumors, segmental disruption of the upper two-thirds of the vaginal wall without parametrial invasion is demonstrated on T2-weighted images. The lack of preservation of low signal intensity cervical stroma is highly indicative of parametrial invasion—stage IIB disease.

Stage III. In stage IIIA, vaginal involvement reaches the lower third of the vaginal canal without extending to the pelvic sidewall. When the tumor extends to the pelvic sidewall (pelvic musculature or iliac vessels) or causes hydronephrosis, it is defined as stage IIIB.

Stage VI. Once tumor invades the adjacent organs such as the bladder and rectal mucosa, or distant metastasis occurs, the stage is defined as IV (Fig. 7.1.15). Disruption of low-signal-intensity bladder, stroma, or rectal wall by high-signal-intensity tumor on T2-weighted images indicates bladder/rectal involvement. In stage IVB, there is distant metastatic disease. Although pelvic node metastases do not change the FIGO stage, para-aortic or inguinal node metastases are classified as stage IVB.



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