IS Case 250: Cervical carcinoma

Wade Hedegard, MD

Imaging Sciences URMC 2008
Publication Date: 2009-05-26

History

Patient is a 45 year-old female with vaginal bleeding.

Findings

T2-weighted axial images demonstrate a mass involving the cervix that is heterogeneously hyperintense to the dark cervical stroma. No definite parametrial extension is identified. Sagittal T2 images show no invasion of the rectum, bladder or vaginal fornices. There is heterogeneous enhancement of the lesion after administration of gadolinium-DTPA.

Diagnosis

Cervical carcinoma

Discussion

Cervical cancer is the third most common gynecologic malignancy. Patients may present with abnormal vaginal discharge, vaginal bleeding or may be asymptomatic. The diagnosis is usually made by Papanicolaou testing or cervical biopsy. Any confirmed invasive disease or tumor larger than 1.5 cm requires imaging with either MRI or CT. The prognosis is based on the stage, size, and histologic grade of the primary tumor. There are four stages of disease as defined by the staging system of the International Federation of Gynecology and Obstetrics (FIGO). Stage I cervical cancer is confined to the cervix. In stage II disease the cancer extends beyond the cervix and in stage III disease the tumor spreads to the pelvic sidewall or causes ureteral obstruction. Stage IV cervical cancer invades the bladder, rectum or extends beyond the pelvis. Distant metastases occur with primary or recurrent disease and can involve the liver, lung and bone. Up to 90% of cervical carcinomas are of squamous cell origin and are usually exophytic or endocervical. Accurate assessment of the stage of disease is important in determining if the patient may benefit from surgery or if they will require radiation and/or chemotherapy. Patients with stage I and IIA disease usually undergo radical hysterectomy, while stage IIB and higher disease is treated with a combination of radiation and chemotherapy.

References

  1. Zagoria RJ. Genitourinary Radiology: The Requisites, 2nd ed., Mosby, 2004: 305-310.
  2. Pannu HK, Corl FM, Fishman EK. CT evaluation of cervical cancer: spectrum of disease. Radiographics. 2001 Sep-Oct;21(5):1155-68. [PMID: 11553823]
  3. Hricak H, Gatsonis C, Coakley FV, et al. Early invasive cervical cancer: CT and MR imaging in preoperative evaluation - ACRIN/GOG comparative study of diagnostic performance and interobserver variability. Radiology. 2007 Nov;245(2):491-8. [PMID: 17940305]

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