Work-up Flashcards
What should be included in the workup for a cervical mass?
Pelvic mass workup: H& P, including a careful pelvic exam in the office, basic labs, and EUA with Bx, with cystoscopy and proctoscopy(if concern for invasion) for any visible lesions. Imaging studies such as CT, PET, and MRI can be obtained for treatment decision making and planning purposes (but do not enter FIGO staging of the pt).
What are the areas at risk for local extension of cervical cancer?
Cervical cancer can spread locally to the corpus, parametria, and vagina. These should be carefully assessed during a physical exam. Tumor size and parametrial involvement are best assessed by rectovaginal exam. Cervical tumors can also spread to bladder anteriorly or rectum posteriorly, but this is rare in North America.
Name 3 routes of lymphatic drainage from the cervix.
Routes of lymphatic drainage from the cervix: 1. Lat to the external iliac nodes 2. Post into common iliac and lat sacral nodes 3. Post-lat into internal iliac nodes
What imaging studies are included in FIGO staging of cervical cancer? What common imaging modalities are not allowed?
CXR, barium enema, and intravenous pyelogram data are included in FIGO staging of cervical cancer, as are procedures such as cystoscopy, proctoscopy, and hysteroscopy. CT, PET, MRI, bone scan, lymphangiography, and laparotomy/ laparoscopy data are not allowed to be used for staging but can be used for decisions regarding management.
What is the utility of PET scans in cervical cancer?
PET is generally fairly sensitive (85%– 90%) and specific (95%– 100%) for detection of para-aortic (P-A) nodes in pts with locally advanced cervical cancer.
In what group of cervical cancer pts is evaluation of the urinary tract required? Cervical cancer pts with more than stage IB1 disease require imaging of the urinary tract.
Cervical cancer pts with more than stage IB1 disease require imaging of the urinary tract. This can be performed with CT, MRI, or intravenous pyelogram.
