Basics of screening and cytological examination
The primary measure for detecting background and precancerous conditions is cervical cancer screening. The baseline method is taking a Pap smear (Pap smear) followed by cytological examination of the smear obtained from the cervical canal. The main goal of this analysis is the timely diagnosis of cervical intraepithelial neoplasia.
According to clinical guidelines, for certain patient groups (e.g., with concomitant ulcerative colitis), such screening must be performed annually. The comprehensive management plan also necessarily includes a full appointment, including an examination and a detailed consultation with an obstetrician-gynecologist. If pathological changes are detected, the cytological examination yields a positive result, after which colposcopy can be used for visual confirmation of the lesion.
Epidemiology and risk factors
Cervical cancer is a global medical problem, ranking second in prevalence among all oncological diseases in women worldwide. The highest incidence is traditionally recorded in developing countries, including regions of Central and South America, Africa, and South-Central Asia. The peak incidence occurs at a young, reproductive age—from 25 to 40 years.
The development of the pathology is closely associated with a number of risk factors. These include:
- Infection with oncogenic strains of human papillomavirus (HPV or HPV), primarily types 16 and 18.
- Early onset of sexual activity, especially with multiple sexual partners.
- Smoking.
- Various immunosuppressive states.
Staging and principles of treatment selection
The disease is usually detected clinically using a Pap smear and physical examination. Once diagnosed, accurate staging is critically important as it determines the further prognosis and treatment strategy. For this, the universally accepted FIG0 clinical staging system is used.
Key prognostic factors include: primary tumor size, tumor grade (grade), depth of stromal invasion, spread of the tumor process to the parametrium, and involvement of regional lymph nodes.
Treatment tactics directly depend on the stage:
- At lower (early) stages, primary surgical intervention may be performed.
- At stage IIb and above, chemoradiotherapy is the standard of care.
Role of diagnostic imaging (ultrasound and CT)
Diagnostic imaging is essential for assessing disease spread, monitoring treatment response, and detecting potential recurrences. Cross-sectional imaging (CT or MRI) is strongly recommended for patients with clinical stage Ib and above, or if the primary tumor size exceeds 2 cm. This is due to the high probability of occult parametrial invasion or lymph node metastasis.
- Ultrasound (US): Transabdominal approach can help identify hydronephrosis. Transrectal and transvaginal ultrasound (TVUS / TVUS) are used to assess the local process. In advanced cancer, the cervix appears as an enlarged, irregular, hypoechoic mass mimicking a leiomyoma. If the tumor obstructs the endocervical canal, fluid or blood accumulates (hydro- or hematometra). Disadvantages of the method include poor soft-tissue contrast and operator dependence.
- Computed tomography (CT): Has limited value in primary diagnosis and assessment of early parametrial invasion (positive predictive value of only 58%). However, CT accuracy reaches 92% in visualizing advanced stages, for example, when tumor extension to the pelvic wall causes ureteral obstruction and hydronephrosis.
Magnetic resonance imaging (MRI)
MRI (MRI) is the imaging method of choice in gynecologic oncology for accurate assessment of the depth of myometrial and cervical stromal invasion. MRI allows high-precision determination of:
- Tumor localization (exophytic or endocervical).
- Exact tumor size.
- Presence of parametrial invasion and extension of the process to the lower uterine segment.
A crucial clinical task of MRI is the reliable differentiation of early stages eligible for surgery from advanced stages requiring mandatory chemoradiotherapy. By comparison, in endometrial carcinoma on T2-weighted MRI (T2WI), the tumor appears as a heterogeneous mass distending the uterine cavity, while PET/CT (PET/CT) is effective for restaging and detecting recurrences.
Class and exam questions
Cross-sectional imaging is recommended for patients with clinical stage Ib and higher, as well as with a primary tumor size greater than 2 cm to rule out parametrial invasion and lymph node metastases.
Cross-sectional imaging (CT and MRI) is indicated for patients with clinical stage Ib and higher, as well as in cases where the primary tumor size exceeds 2 centimeters.
Why is ultrasound not the primary staging method for cervical cancer?
Transvaginal and transrectal ultrasound are limited by a small field of view, operator dependence, and poor soft-tissue contrast, which prevents a reliable assessment of parametrial involvement and pelvic wall extension.
What symptoms are most characteristic of cervical carcinoma?
The main clinical manifestations are abnormal vaginal discharge and uterine bleeding, which most commonly occur after sexual intercourse (postcoital).
What else to study on this topic
- FIGO clinical staging system for cervical cancer.
- MRI semiotics of endometrial and adnexal tumors (T2-weighted images).
- Mechanism of hydronephrosis development in locally advanced gynecologic oncology processes.
- Role of PET/CT in restaging and detecting pelvic tumor recurrences.
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