Summary: Using intravaginal gel during pelvic MRI sharpens early lesion detection, while inspecting nodal chains upfront prevents under-staging advanced disease.
Node Cap: HPV subtypes 16 & 18 cause the majority of cervical cancers. And according to Dr. Venkata Katabathina in our Essentials in Women’s Imaging Online Course, your approach to HPV-related cervical cancer is decidedly multimodal.
- Pelvic MRI: Key for assessing local disease extent, cervical stromal invasion, parametrial involvement, and complications (hydronephrosis, pelvic organ extension).
- Intravaginal gel improves contrast visualization of small luminal tumors and clarifies early FIGO Stage 1B (category T1b1) disease.
- PET-CT & CT: IDs pelvic and retroperitoneal lymphadenopathy, as well as distant metastatic spread.
Your report should be systematic, addressing primary tumor, depth of stromal invasion, parametrial extension, adjacent organ involvement, lymph node status, and distant metastatic disease.
- First, Lymph Nodes: Any positive pelvic lymph node elevates disease to FIGO Stage IIIC1; positive retroperitoneal lymph nodes advance to IIIC2.
- Endocervical vs. Endometrial: When distinguishing endocervical adenocarcinoma from endometrial carcinoma, locate the tumor epicenter—endocervical lesions center in the cervix, despite potential endometrial extension.
- Local Invasion: Involvement of the bladder or rectal mucosa, or the presence of a vesicovaginal fistula, indicates FIGO Stage IVA (category T4).
- Distant Metastases: Peritoneal disease, distant visceral spread, or remote skeletal lesions, like PET-positive tibial metastases, define FIGO Stage IVB.
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