Investigations

Question 1

When should an MRI be performed after biopsy and why?

Answer 1

at least 7-10 days after biopsy because post-biopsy changes can mimic malignancy.

Question 2

What investigations are required in a cervical cancer beyond stage IA1

Answer 2

visual inspection of the cervix and vagina with BME (assess parametrium and vaginal extension)

PR or rectovaginal examination

EUA if required (especially if there is discrepancy between examination and imaging)

MRI

Pre-op CXR

FDG PET/CT (should be used in cases over 1B2 or if planned for chemorad)

Question 3

what is the best way of assessing:

vaginal involvement

parametrial involvement

bladder and bowel involvement

nodes

Answer 3

vaginal - examination

Question 4

what is the best way of assessing:

parametrial involvement

Answer 4

parametrium - MRI

Question 5

what is the best way of assessing:

bladder and bowel involvement

Answer 5

bladder/bowel - MRI

if in doubt - EUA and cystoscopy

Question 6

what is the best way of assessing:

nodes

Answer 6

nodes - PET/CT is best on imaging, with MRI and CT being equally sensitive but really surgical staging is gold standard