ACR Codes: 8.3
Cervical cancer is the most common female malignancy in those less than 50 years of age and third most common GU malignancy overall. There are multiple risk factors for the development of cervical cancer which include: 1. age < 20yrs at first coitus, 2. multiple sexual partners, 3. history of STDs, and 4. condylomas
The majority of cervical cancers are asymptomatic and found on routine examinations. However, once the cancer becomes invasive there is a tendency for vaginal bleeding. The majority of cancers are squamous cell carcinomas, but there has been an increasing prevalence of adenocarcinoma recently.
CT findings in cervical cancer include enlargement of the cervix. After administration of IV contrast, low-attenuation areas may be seen within the tumor, related to regions of ulceration or necrosis. Obstruction of the endocervical canal can result in uterine enlargement with a fluid-filled endometrial cavity.
There has been increasing use of MRI for tumor evaluation and staging purposes. Recent studies suggest that MRI is superior to US or conventional CT for delineation of the primary tumor site, in the assessment of tumor size, and the evaluation of disease extent.
On T2-weighted images, the cervical cancer is of intermediate to high signal intensity with the surrounding normal cervical stroma (which is composed of dense collagen tissue) being of low signal intensity. On T1-weighted images, tumors are usually isointense with the normal cervix and may not be visible.
STAGING:
Ia: confined to cervix
Ib: extends to uterus
IIa: extends into upper vagina (important cut-off)
IIb: parametrial involvement
IIIa: extends into lower vagina
IIIb: pelvic wall (hydronephrosis)
IVa: spread to adjacent organs
IVb: spread to distant organs
Accurate staging of cervical cancer is important for prognosis and for determining appropriate therapy. The staging of cervical cancer is based up the extent of local invasion or distant metastasis. The important clinical point is the differentitation of stage IIa from IIb. Carcinomas which are graded IIa or less may be treated surgically while IIb and higher are not surgical candidates and treated with chemotherapy and radiation.
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Disease Topic 4404 
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