Cervical%20cancer%20-%20treatment Diagnosis

• 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)

• 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

• 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.