Assessing disease extent in women with bulky or clinically evident metastatic cervical cancer: Yield of pretreatment studies

Objective. The objective of this study was to determine the impact of pretr eatment tests on staging and management for women with bulky or clinically evident metastatic cervical cancer. Methods. Demographics and findings of clinic pelvic examination (PE), exami nation under anesthesia (EUA), chest x ray (CXR), abdominopelvic computed t omography (CT), and intravenous urography (IVU) were reviewed for women wit h primary, untreated cervical cancers either greater than or equal to 4 cm or with extracervical disease apparent on PE or CXR evaluated between July 1, 1994, and March 31, 1999. Stage was assigned according to standards of t he International Federation of Gynecology and Obstetrics. Results. In 133 women studied, tumor diameter averaged 4.9 cm on PE and 5.7 cm at EUA (P = 0.0005). Of 92 women undergoing both PE and EUA, 30 (33%) h ad size discrepancies of more than 1 cm. Compared with EUA, PE had sensitiv ity, specificity, and positive and negative predictive values, respectively , of 65, 89, 79, and 81% for vaginal disease, 74, 91, 95, and 63% for param etrial disease, and 57, 90, 60, and 89% for sidewall fixation. CXR was abno rmal in 5 (4%). IVU showed ureteral dilation in 20 (22%) of 90 women, while CT showed dilation in 34 (28%) of 123 women. CT also showed pelvic lymphad enopathy in 22 (18%) women and paraaortic lymphadenopathy in 12 (10%). Blad der biopsies showed malignancy in 8 (8%), including one transitional cell c arcinoma of the bladder. Proctoscopy failed to reveal metastatic cervical c ancer. Conclusions. CXR and EUA with cystoscopy are important to the accurate stag ing and treatment of bulky or clinically metastatic cervical cancers, while proctoscopy is rarely useful. CT predicts ureteral obstruction well, and i ts greater information yield may justify its higher cost compared with IVU. (C) 2000 Academic Press.