CERVICAL CANCER

CERVICAL CANCER

FIGO stage:

-0 Carcinoma in situ (before invasion)

-I Confined to cervix
--Ia microinvasion of stroma
--Ib invasion confined to cervix

-II Extension beyond cervix but not to pelvic wall / lower third of vagina
--IIa vaginal invasion excluding lower 1/3
--IIb parametrial involvement excepting pelvic sidewall

-III Extension to pelvic wall / lower third of vagina
--IIIa invasion of lower 1/3 of vagina
--IIIb parametrial involvement to pelvic wall

--IVa mucosal involvement of bladder / rectum
--IVb spread to distant organs (paraaortic / inguinal nodes, intraperitoneal metastasis)

Significance of tumor size:

-->4 cm:
nodal metastases (80%), local recurrence (40%), distant metastases (28%)

--<4 cm:
nodal metastases (16%), local recurrence (5%), distant metastases ( 0%) -leukorrhea ± vaginal bleeding (<30%)

-postcoital bleeding / metrorrhagia

-bulky enlargement of cervix (DDx: cervical fibroid)

-fluid-filled uterus (secondary to obstruction)

-signs of parametrial invasion: >4-mm soft-tissue strands extending from cervix into parametria, cardinal / sacrouterine ligaments, irregularity of cervical margins, eccentric parametrial enlargement, obliteration of fat planes

MR (76-83% accuracy for staging, 82-92% accuracy for parametrial involvement):
-isointense mass on T1WI

-hyperintense focal bulge / mass on T2WI (DDx: postbiopsy changes, inflammation, nabothian cysts)

-blurring + widening of junctional zone secondary to obstruction of cervical os (retained secretions in uterine cavity)

Prognosis:
-local recurrence (usually within 2 years)