CT evaluation of cervical cancer: Spectrum of disease

Invasive cervical cancer is the third most common gynecologic malignancy. T he prognosis is based on the stage, size, and histologic grade of the prima ry tumor and the status of the lymph nodes. Assessment of the stage of dise ase is important in determining whether the patient may benefit from surger y or will receive radiation therapy. The official clinical staging system o f the International Federation of Gynecology and Obstetrics has led to erro rs of 65%-90% in stage III and IV disease; the result has been unofficial e xtended staging with cross-sectional imaging modalities such as computed to mography (CT). CT is useful in staging advanced disease and in monitoring p atients for recurrence. The primary tumor is heterogeneous and hypoattenuat ing relative to normal stroma on contrast material-enhanced scans. Oblitera tion of the periureteral fat plane and a soft-tissue mass are the most reli able signs of parametrial extension. Less than 3 mm separation of the tumor from the pelvic muscles and vascular encasement are signs of pelvic side w all invasion. Lymphatic spread is along the external and internal iliac nod al chains and the presacral route to the paraaortic nodes. Distant metastas es are seen with primary or recurrent disease and can involve the liver, lu ng, and bone.