Cervical%20cancer%20-%20treatment Diagnosis
Laboratory Tests
- Complete blood count (CBC) with platelet count
- Liver function tests (LFTs)
- Renal function tests
- Urinalysis
Additional Tests
- Biomarkers for programmed death-ligand 1 (PD-L1) and microsatellite instability and mismatch repair deficiency (MSI/MMR) in patients with recurrent, progressive, or metastatic disease
- Cystoscopy and proctoscopy under anesthesia should be reserved for patients in whom there is suspicion of bladder or rectal extension
- Intravenous pyelogram (IVP)
Imaging
- Positron emission tomography (PET)-computed tomography (CT) (PET-CT) scan
- PET/CT scan may be used to rule out extrapelvic disease, detect persistent disease or recurrences which may respond to curative salvage therapy
- PET is used to define the nodal volume of coverage, especially in patients who are not surgically staged
- Magnetic resonance imaging (MRI)
- Superior to CT in determining tumor extension such as soft tissue and parametrial involvement, and equal to CT for nodal involvement evaluation
- Used to evaluate extent of local disease, to rule out diseases that are high in the endocervical area and to assist in radiation treatment planning
- CT scan
- Transvaginal/transrectal ultrasound with doppler studies
- Bone scan
- Chest X-ray
Staging
- Cervical cancer is clinically staged
- Staging is for comparison purposes only and not as a treatment guide
Clinical Findings | FIGO Stages | TNM Stages |
Cervical carcinoma confined to cervix (extension to uterine corpus should be disregarded) | I | T1 |
- Invasive carcinoma diagnosed only by microscopy, with deepest invasion of ≤5 mm |
IA | T1a |
- Stromal invasion ≤3 mm in depth |
IA1 | T1a1 |
- Stromal invasion >3 mm and ≤5 mm |
IA2 | T1a2 |
- Invasive carcinoma with deepest invasion >5 mm (>stage IA); lesion is confined to the cervix with size measured by maximum tumor diameter2 |
IB | T1b |
- Invasive carcinoma with deepest invasion >5 mm and ≤2 cm in greatest dimension |
IB1 | T1b1 |
- Invasive carcinoma with deepest invasion >2 cm and ≤4 cm in greatest dimension |
IB2 | T1b2 |
- Invasive carcinoma >4 cm in greatest dimension |
IB3 | |
Cervical carcinoma invades beyond the uterus but not to pelvic wall or to lower 3rd of vagina | II | T2 |
- Involves up to the upper 2/3 of vagina; without parametrial invasion |
IIA | T2a |
- Invasive carcinoma ≤4 cm in greatest dimension |
IIA1 | T2a1 |
- Invasive carcinoma >4 cm in greatest dimension |
IIA2 | T2a2 |
- With parametrial invasion but no extension to pelvic sidewall |
IIB | T2b |
Carcinoma extends to pelvic wall and/or involves lower 3rd of vagina and/or causes hydronephrosis or non-functioning kidney and/or involves pelvic and/or para-aortic lymph nodes | III | T3 |
- Carcinoma involves lower 3rd of vagina with no extension to pelvic wall |
IIIA | T3a |
- Carcinoma extends to pelvic wall and/or causes hydronephrosis or non-functioning kidney |
IIIB | T3b |
- Invades pelvic and/or para-aortic lymph nodes including micrometastases3 irrespective of tumor size and extent and with r and p notations4 |
IIIC | |
- Pelvic lymph node metastasis only | IIIC1 | |
- Para-aortic lymph node metastasis | IIIC2 | N1 |
Carcinoma extends beyond the true pelvis or invades bladder or rectal mucosa. The presence of bullous edema is not sufficient to classify a tumor as stage IV | IV | T4 |
- Adjacent pelvic organs spread present |
IVA | T4 |
- Presence of distant metastasis |
IVB | M1 |
1References: Bhatla N, Berek JS, Fredes MC, et al. Revised FIGO staging for carcinoma of the cervix uteri. Int J Gynaecol Obstet. 2019 Apr;145(1):129-135; National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: cervical cancer. Version 1.2022. NCCN. https://www.nccn.org/. 26 Oct 2021.
2Involvement of lymphatic or vascular spaces will not change the staging and lateral extent of the lesion is no longer considered.
3Isolated tumor cells do not change the stage but presence should be recorded.
4Notation of r (imaging) and p (pathology) is added to indicate the results which are used to allocate the case to stage IIIC.