الفهرس Only 14 pages are availabe for public view
 |  | from | 195 |  |  |
| | | from | 195 | | |
Abstract
Worldwide, cervical cancer is the second most common gynecologic malignancy and is typically seen in younger women. Cervical cancers start in the lining epithelium of the cervix. The majority of cervical cancers are from squamous cells. The development of cervical cancer is very slow. It starts as a pre-cancerous condition called dysplasia. It usually takes years for pre-cancerous changes to turn into cervical cancer. This pre-cancerous changes when detected is 100% treatable. Patients with cervical cancer do not usually have problems until the cancer is advanced and has spread. Pap smears are used for screening pre-cancers and cancer, but do not offer the final diagnosis. If abnormal changes are found, the cervix is usually examined under magnification (colposcopy) and conically biopsied.
Once cervical cancer is diagnosed its stage must be determined. Accurate cervical cancer staging is crucial for appropriate treatment selection and treatment planning. Armed with information about the extent and volume of cervical lesion, the clinician can plan fertility conserving or radical surgery, chemo or radiotherapy with greater confidence.
Staging is based on clinical FIGO criteria that include findings from physical examination, colposcopy, lesion biopsy, radiologic studies (e.g. chest radiography, intravenous urography, and barium enema), and endoscopic studies (e.g. cystoscopy, sigmoidoscopy). Compared with surgical staging, FIGO clinical staging has been shown to be in accurate. The greatest difficulties in the clinical staging are the estimation of tumor size, especially if the tumor is primarily endocervical in location, the assessment of parametrial and pelvic sidewall invasion and the evaluation of lymph node and distant metastases. Modern cross-sectional imaging, which can assist in the evaluation of these prognostic factors, has become an important adjunct to the clinical assessment of cervical cancer. There is a body of literature showing the superiority of CT and MRI to clinical staging.
MRI has excellent soft-tissue contrast resolution, which exceeds that of CT and US. Consequently, MRI is significantly more valuable in the assessment of the size of the tumor, the depth of cervical invasion, and the local-regional extent of the disease. CT and MRI are approximately equivalent, and both are significantly superior to US, in the detection of enlarged lymph nodes, Thus CT and MRI are more accurate staging modalities but they are not warranted in patients with small-volume early disease (<2 cm³) because of the low probability of parametrial invasion and nodal metastasis.