Invasive cervical cancer: Staging and evaluation of lymph nodes
- Michael Frumovitz, MD, MPH
Michael Frumovitz, MD, MPH
- Professor of Gynecologic Oncology
- MD Anderson Cancer Center
- Section Editors
- Barbara Goff, MD
Barbara Goff, MD
- Section Editor — Gynecologic Oncology
- Professor of Gynecologic Oncology
- University of Washington
- Deborah Levine, MD
Deborah Levine, MD
- Section Editor — Imaging
- Professor of Radiology
- Director of Ob/Gyn Ultrasound
- Department of Radiology
- Beth Israel Deaconess Medical Center
Cancer of the uterine cervix is staged using a clinical, rather than a surgical staging system, which is the approach used for other gynecologic tumors [1,2]. Surgical staging is potentially more accurate . However, the International Federation of Gynecology and Obstetrics (FIGO) has determined that clinical staging is preferable for several reasons: it is more accessible for low resource settings, in which cervical cancer remains the most common malignancy among women; it may be better for assessing locally advanced disease (ie, tumor size, vaginal and parametrial involvement); and it avoids surgery in women who are not candidates for surgical treatment .
Tumor stage is determined at the time of primary diagnosis of cervical cancer and is not altered, even upon recurrence. This convention also applies to other gynecologic cancers. Accurate pretreatment staging of cervical cancer is critical, as it determines therapy (ie, surgery, chemoradiation, chemotherapy alone) and prognosis (table 1).
The staging and evaluation of lymph nodes for cervical cancer will be reviewed here. Cervical cancer screening and prevention, epidemiology, risk factors, clinical manifestations, diagnosis, and treatment are discussed separately. (See "Screening for cervical cancer" and "Invasive cervical cancer: Epidemiology, risk factors, clinical manifestations, and diagnosis" and "Management of early-stage cervical cancer" and "Management of locally advanced cervical cancer" and "Cervical intraepithelial neoplasia: Management of low-grade and high-grade lesions".)
The diagnosis of cervical cancer is made based upon histologic evaluation of a cervical biopsy. After histologic confirmation, the extent of disease is determined. Two parallel staging systems are available, both of which use clinical rather than surgical criteria to assign disease stage (see 'Staging procedure' below). The corresponding stages of the two systems are shown in the table (table 2).
FIGO system — The International Federation of Gynecology and Obstetrics (FIGO) collaborated with the International Union Against Cancer (IUCC) to formulate the most recent version of the FIGO system for cervical cancer [1-3]. The FIGO staging system is largely based upon physical examination and a limited number of endoscopic diagnostic procedures and imaging studies (see 'Staging procedure' below). The FIGO system is used more commonly than the Tumor, Nodes, Metastasis (TNM) system.
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- STAGING SYSTEMS
- FIGO system
- TNM system
- STAGING PROCEDURE
- FURTHER EVALUATION
- Imaging studies
- - Clinical approach
- - Tumor size and local spread
- - Lymph node metastases
- - Upper urinary tract involvement
- Surgical evaluation of lymph nodes
- - Lymph node dissection
- - Sentinel lymph node biopsy
- Laboratory evaluation
- - Routine evaluation
- - Tumor markers
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS