Cervical Carcinoma

Imaging

• Soft tissue mass in cervix: Hypoechoic or isoechoic ± necrosis

• Hydro- or hematometra from cervical obstruction

• Mass extending into upper vagina

• MR is best modality for local staging and planning of radiation therapy

  • Tumor: Intermediate- to high-signal mass replacing dark cervical stroma on T2-weighted sequences

  • Accuracy superior to FIGO staging for size, parametrial extension, lymph nodes

  • Parametrial invasion: Accuracy: 88-97%, specificity: 93%, negative predictive value: 94-100%

• PET/CT best modality for overall staging: Nodal disease, liver, bone, and lung metastases

• Revised FIGO staging uses information from CT or MR; cystoscopy and sigmoidoscopy not mandatory

• Invasion of posterior bladder wall, anterior rectal wall, ureters

  • Hydronephrosis implies stage IIIB disease

• Enlarged lymph nodes

• Abundant internal color flow on color Doppler

• 3D US may be used to assess tumor volume before/after therapy

• Ultrasound may be used to guide placement of radiotherapy instruments