Soft tissue mass in cervix: Hypoechoic or isoechoic ± necrosis

Hydro- or hematometra from cervical obstruction

Mass extending into upper vagina

MR is best modality for local staging and planning of radiation therapy

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  Tumor: Intermediate- to high-signal mass replacing dark cervical stroma on T2-weighted sequences

  
  
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  Accuracy superior to FIGO staging for size, parametrial extension, lymph nodes

  
  
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  Parametrial invasion: Accuracy: 88-97%, specificity: 93%, negative predictive value: 94-100%

PET/CT best modality for overall staging: Nodal disease, liver, bone, and lung metastases

Revised FIGO staging uses information from CT or MR; cystoscopy and sigmoidoscopy not mandatory

Invasion of posterior bladder wall, anterior rectal wall, ureters

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  Hydronephrosis implies stage IIIB disease

Enlarged lymph nodes

Abundant internal color flow on color Doppler

3D US may be used to assess tumor volume before/after therapy

Ultrasound may be used to guide placement of radiotherapy instruments

Cervical fibroid

Cervical polyp

Endometrial cancer invading cervix

Adenoma malignum/minimal deviation adenocarcinoma

Rarer cervical tumors: Lymphoma, neuroendocrine/small cell carcinoma

~ 80-90% are squamous carcinoma

Arise at squamocolumnar junction from precursor lesions

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  Cervical intraepithelial neoplasia grades I-III

Stage I: Confined to cervix

Stage II: Beyond uterus but not to pelvic sidewall or lower 1/3 of vagina

Stage III

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  IIIA: Lower 1/3 of vagina

  
  
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  IIIB: Pelvic side wall (within 3 mm of obturator internus, levator ani or pyriformis muscles, or iliac vessels) or hydronephrosis/nonfunctioning kidney

Stage IV: Bladder/rectal involvement or distant metastases (lung, liver, bones)

Presence of pelvic or paraaortic lymphadenopathy alters prognosis but not FIGO stage

Abnormal bleeding, pain, or discharge

Detected by screening cytology from Pap smear

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  ± testing for high-risk HPV

3rd most common gynecologic malignancy in USA and most common gynecologic malignancy worldwide

Risk factors: HPV infection most important, early-onset sexual activity, multiple partners, smoking, immunosuppression, HIV infection

Look for disruption of normal cervical morphology

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  And for abnormal color flow