Staging cervical cancer-current and future perspectives

Abstract

Cervical cancer (CC) represents the third most commonly diagnosed cancer and the fourth cause of cancer death in women worldwide. Clinical examination is the basis for the FIGO classification. Nodal metastasis in patients with locally advanced CC, together with tumor volume and clinical stage, is the strongest prognostic factor for survival and the most important prognostic factor for disease recurrence together with tumor stage is the para-aortic (PA) nodal status. MRI is the preferred method to assess local spread of cervical tumors. However, PET seems to be more sensitive than MRI for detecting pelvic and PA nodal involvement. Hybrid MRI-PET is an emerging modality that involves no associated radiation exposure and offers the high soft tissue resolution of MRI. Fused images from MRI and PET had higher diagnostic value than PET CT for detection of metastatic nodes in patients with CC. Surgical staging of patients with locally advanced CC may lead to treatment modification in 20- 40% of the patients, resulting in improved survival. In early stage CC, sentinel lymph node (SLN) biopsy is currently under investigation. Although CC is a commonly diagnosed disease among women worldwide, there is still a long way to go until optimal screening, staging and management can be achieved. Large randomized controlled trials are needed to provide more accurate information about the ideal staging procedures and its efficacy and relation with survival rates