Q: What is the main abnormality ?
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A: There is a mass involving the cervix
Q: What additional abnormality is present within the uterus ?
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A: There is an exophytic fundal leiomyoma
Q: What extra uterine abnormality is seen ?
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A: There is complicating bilateral obstructive hydronephrosis
Q: How is cervical carcinoma staged?
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A: The FIGO staging system is historically based on clinical and surgical staging using examination under anaesthesia, cystoscopy and proctoscopy. The 2009 revised FIGO staging now encourages imaging as an adjunct to clinical staging. MRI is the imaging modality of choice for local disease extent and CT or PET has a role for detecting distant disease.
Q: What are the pitfalls in reporting MRI in cases of cervical carcinoma?
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A: The accuracy of MRI in staging cervical carcinoma is variable in the literature. It has a high negative predictive value in excluding parametrial, bladder and rectal invasion. However inflammatory tumours may cause changes within the parametrium which is misinterpreted as parametrial invasion with a consequent upstaging of disease.
The FIGO staging and definition of bladder and rectal involvement is biopsy proven involvement of the mucosa. MRI may be over sensitive in staging advanced disease if there there is not full thickness involvement of the adjacent organs.
Q: How is the management of the patient determined by the stage of the tumour?
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A: Conventionally tumours greater than 4cm in maximum dimension or stage IIB and above are non amenable to primary surgical management. First line treatment in these cases in combined chemotherapy and radiotherapy.
Q: What is worse in terms of staging ? - causing obstructive uropathy or rectal invasion ?
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A: Rectal invasion
Q: What is the significance of obstructive uropathy alone on staging of the disease ?
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A: It places the disease at stage IIIb
Q: What is the significance of rectal invasion alone on staging of the disease ?
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A: It places the disease at stage IVa
Q: What is the commonest histological sub type of carcinoma of the cervix ?
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A: Squamous cell carcinoma of the cervix : accounts of 80 - 90 % of cases
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