Skip to main content
SpringerLink
Log in

Cervical Cancer

  • Chapter
  • First Online:
Nuclear Medicine Manual on Gynaecological Cancers and Other Female Malignancies

  • 256 Accesses

Abstract

Cervical cancer is the fourth most frequent cancer in women worldwide and about 80% are squamous cell carcinoma. Staging of cervical cancer is defined according to the revised 2018 FIGO staging system including pelvic and para-aortic node involvement that is the most important prognostic factor. According to the current guidelines, sentinel node biopsy is advised in early-stage patients with clinically negative nodes. For sentinel node mapping, preoperative SPECT/CT images provide a precise anatomic localization of sentinel nodes, depiction of additional sentinel nodes, or close to the primary tumour (parametrial nodes) or located in uncommon areas (para-aortic nodes); thus preoperative imaging is useful to plan a tailored surgical approach. For clinical routine, PET/CT using glucose analogue (18F-FDG) is indicated in patients with locally advanced cervical cancer for staging nodal and distant disease and therapy planning as well as for prognostic stratification, response assessment, and restaging for suspected recurrence.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 16.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424. https://doi.org/10.3322/caac.21492.

    Article  PubMed  Google Scholar 

  2. SEER Cancer Stat Facts: Cervical Cancer. National Cancer Institute, Bethesda. https://seer.cancer.gov/statfacts/html/cervix.html. Accessed Dec 2021.

  3. Dugué PA, Rebolj M, Garred P, Lynge E. Immunosuppression and risk of cervical cancer. Expert Rev Anticancer Ther. 2013;13(1):29–42. https://doi.org/10.1586/era.12.159.

    Article  CAS  PubMed  Google Scholar 

  4. Kjær SK, Frederiksen K, Munk C, Iftner T. Long-term absolute risk of cervical intraepithelial neoplasia grade 3 or worse following human papillomavirus infection: role of persistence. J Natl Cancer Inst. 2010;102(19):1478–88. https://doi.org/10.1093/jnci/djq356.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Inzani F, Santoro A, Angelico G, Feraco A, Spadola S, Arciuolo D, et al. Neuroendocrine carcinoma of the uterine cervix: a clinicopathologic and immunohistochemical study with focus on novel markers (Sst2–Sst5). Cancers (Basel). 2020;12(5):1211. https://doi.org/10.3390/cancers12051211.

    Article  CAS  Google Scholar 

  6. WHO classification of Tumours Editorial Board. Female genital tumours. In: WHO classification of tumours. 5th ed. Lyon: International Agency for Research on Cancer; 2020.

    Google Scholar 

  7. Bhatla N, Berek JS, Cuello Fredes M, Denny LA, Grenman S, Karunaratne K, et al. Revised FIGO staging for carcinoma of the cervix uteri. Int J Gynaecol Obstet. 2019;145:129–35. https://doi.org/10.1002/ijgo.12749.

    Article  PubMed  Google Scholar 

  8. Benedetti-Panici P, Maneschi F, Scambia G, Greggi S, Cutillo G, D’Andrea G, et al. Lymphatic spread of cervical cancer: an anatomical and pathological study based on 225 radical hysterectomies with systematic pelvic and aortic lymphadenectomy. Gynecol Oncol. 1996;62(1):19–24. https://doi.org/10.1006/gyno.1996.0184.

    Article  CAS  PubMed  Google Scholar 

  9. Altgassen C, Hertel H, Brandstädt A, Köhler C, Dürst M, Schneider A. Multicenter validation study of the sentinel lymph node concept in cervical cancer: AGO study group. J Clin Oncol. 2008;26(18):2943–51. https://doi.org/10.1200/JCO.2007.13.8933.

    Article  PubMed  Google Scholar 

  10. Bats AS, Frati A, Mathevet P, Orliaguet I, Querleu D, Zerdoud S, et al. Contribution of lymphoscintigraphy to intraoperative sentinel lymph node detection in early cervical cancer: analysis of the prospective multicenter SENTICOL cohort. Gynecol Oncol. 2015;137(2):264–9. https://doi.org/10.1016/j.ygyno.2015.02.018.

    Article  PubMed  Google Scholar 

  11. Bats AS, Mathevet P, Buenerd A, Orliaguet I, Mery E, Zerdoud S, et al. The sentinel node technique detects unexpected drainage pathways and allows nodal ultrastaging in early cervical cancer: insights from the multicenter prospective SENTICOL study. Ann Surg Oncol. 2013 Feb;20(2):413–22. https://doi.org/10.1245/s10434-012-2597-7.

    Article  PubMed  Google Scholar 

  12. Cibula D, Abu-Rustum NR, Dusek L, Slama J, Zikán M, Zaal A, et al. Bilateral ultrastaging of sentinel lymph node in cervical cancer: lowering the false-negative rate and improving the detection of micrometastasis. Gynecol Oncol. 2012 Dec;127(3):462–6. https://doi.org/10.1016/j.ygyno.2012.08.035.

    Article  PubMed  Google Scholar 

  13. Lécuru F, Mathevet P, Querleu D, Leblanc E, Morice P, Daraï E, et al. Bilateral negative sentinel nodes accurately predict absence of lymph node metastasis in early cervical cancer: results of the SENTICOL study. J Clin Oncol. 2011;29(13):1686–91. https://doi.org/10.1200/JCO.2010.32.0432.

    Article  PubMed  Google Scholar 

  14. Abu-Rustum NR, Yashar CM, Bradley K, Brooks R, Campos SM, Chino J, et al. Cervical Cancer: version 1.2022. In: NCCN Clinical Practice Guidelines in Oncology (NCCN guidelines); 2021. https://www.nccn.org/professionals/physician_gls/pdf/cervical.pdf. Accessed 12 Dec 2021.

  15. Cormier B, Diaz JP, Shih K, Sampson RM, Sonoda Y, Park KJ, et al. Establishing a sentinel lymph node mapping algorithm for the treatment of early cervical cancer. Gynecol Oncol. 2011;122(2):275–80. https://doi.org/10.1016/j.ygyno.2011.04.023.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Giammarile F, Bozkurt MF, Cibula D, Pahisa J, Oyen WJ, Paredes P, et al. The EANM clinical and technical guidelines for lymphoscintigraphy and sentinel node localization in gynaecological cancers. Eur J Nucl Med Mol Imaging. 2014;41:1463–77. https://doi.org/10.1007/s00259-014-2732-8.

    Article  PubMed  Google Scholar 

  17. Paredes P, Vidal-Sicart S, Campos F, Tapias A, Sánchez N, Martínez S, et al. Role of ICG-99mTc-nanocolloid for sentinel lymph node detection in cervical cancer: a pilot study. Eur J Nucl Med Mol Imaging. 2017;44(11):1853–61. https://doi.org/10.1007/s00259-017-3706-4.

    Article  CAS  PubMed  Google Scholar 

  18. Collarino A, Zurru A, Vidal-Sicart S. Preoperative and intraoperative lymphatic mapping for Radioguided sentinel node biopsy in cancers of the female reproductive system. In: Mariani G, Vidal-Sicart S, Valdés Olmos R, editors. Atlas of lymphoscintigraphy and sentinel node mapping. Cham: Springer; 2020. https://doi.org/10.1007/978-3-030-45296-4_14.

    Chapter  Google Scholar 

  19. Belhocine TZ, Prefontaine M, Lanvin D, Bertrand M, Rachinsky I, Ettler H, et al. Added-value of SPECT/CT to lymphatic mapping and sentinel lymphadenectomy in gynaecological cancers. Am J Nucl Med Mol Imaging. 2013;3(2):182–93.

    PubMed  PubMed Central  Google Scholar 

  20. Kraft O, Havel M. Detection of sentinel lymph nodes in gynecologic tumours by planar scintigraphy and SPECT/CT. Mol Imaging Radionucl Ther. 2012;21(2):47–55. https://doi.org/10.4274/Mirt.236.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Martínez A, Zerdoud S, Mery E, Bouissou E, Ferron G, Querleu D. Hybrid imaging by SPECT/CT for sentinel lymph node detection in patients with cancer of the uterine cervix. Gynecol Oncol. 2010;119(3):431–5. https://doi.org/10.1016/j.ygyno.2010.08.001.

    Article  PubMed  Google Scholar 

  22. Pandit-Taskar N, Gemignani ML, Lyall A, Larson SM, Barakat RR, Abu Rustum NR. Single photon emission computed tomography SPECT-CT improves sentinel node detection and localization in cervical and uterine malignancy. Gynecol Oncol. 2010;117(1):59–64. https://doi.org/10.1016/j.ygyno.2009.12.021.

    Article  PubMed  Google Scholar 

  23. Collarino A, Vidal-Sicart S, Perotti G, Valdés Olmos RA. The sentinel node approach in gynaecological malignancies. Clin Transl Imaging. 2016;4:411–20. https://doi.org/10.1007/s40336-016-0187-6.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Damian A, Lago G, Rossi S, Alonso O, Engler H. Early detection of bone metastasis in small cell neuroendocrine carcinoma of the cervix by 68Ga-DOTATATE PET/CT imaging. Clin Nucl Med. 2017;42(3):216–7. https://doi.org/10.1097/RLU.0000000000001498.

    Article  PubMed  Google Scholar 

  25. Boellaard R, Delgado-Bolton R, Oyen WJG, Giammarile F, Tatsch K, Eschner W, et al. FDG PET/CT: EANM procedure guidelines for tumour imaging: version 2.0. Eur J Nucl Med Mol Imaging. 2015;42(2):328–54. https://doi.org/10.1007/s00259-014-2961-x.

    Article  CAS  PubMed  Google Scholar 

  26. Lakhani A, Khan SR, Bharwani N, Stewart V, Rockall AG, Khan S, et al. FDG PET/CT pitfalls in gynecologic and genitourinary oncologic imaging. Radiographics. 2017;37(2):577–94. https://doi.org/10.1148/rg.2017160059.

    Article  PubMed  Google Scholar 

  27. Adam JA, van Diepen PR, Mom CH, Stoker J, van Eck-Smit BLF, Bipat S. [18F]FDG-PET or PET/CT in the evaluation of pelvic and para-aortic lymph nodes in patients with locally advanced cervical cancer: a systematic review of the literature. Gynecol Oncol. 2020;159(2):588–96. https://doi.org/10.1016/j.ygyno.2020.08.021.

    Article  CAS  PubMed  Google Scholar 

  28. Gouy S, Morice P, Narducci F, Uzan C, Martinez A, Rey A, et al. Prospective multicenter study evaluating the survival of patients with locally advanced cervical cancer undergoing laparoscopic para-aortic lymphadenectomy before chemoradiotherapy in the era of positron emission tomography imaging. J Clin Oncol. 2013;31(24):3026–33. https://doi.org/10.1200/JCO.2012.47.3520.

    Article  PubMed  Google Scholar 

  29. Kidd EA, Spencer CR, Huettner PC, Siegel BA, Dehdashti F, Rader JS, et al. Cervical cancer histology and tumor differentiation affect 18F-fluorodeoxyglucose uptake. Cancer. 2009;115(15):3548–54. https://doi.org/10.1002/cncr.24400.

    Article  PubMed  Google Scholar 

  30. Lin A, Ma S, Dehdashti F, Markovina S, Schwarz J, Siegel B, et al. Detection of distant metastatic disease by positron emission tomography with 18 F-fluorodeoxyglucose (FDG-PET) at initial staging of cervical carcinoma. Int J Gynecol Cancer. 2019;29(3):487–91. https://doi.org/10.1136/ijgc-2018-000108.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Nguyen NC, Beriwal S, Moon CH, Furlan A, Mountz JM, Rangaswamy B. 18F-FDG PET/MRI primary staging of cervical Cancer: a pilot study with PET/CT comparison. J Nucl Med Technol. 2020;48(4):331–5. https://doi.org/10.2967/jnmt.120.247080.

    Article  PubMed  Google Scholar 

  32. Kidd EA, Siegel BA, Dehdashti F, Grigsby PW. The standardized uptake value for F-18 fluorodeoxyglucose is a sensitive predictive biomarker for cervical cancer treatment response and survival. Cancer. 2007;110(8):1738–44. https://doi.org/10.1002/cncr.22974.

    Article  PubMed  Google Scholar 

  33. Kidd EA, Siegel BA, Dehdashti F, Grigsby PW. Pelvic lymph node F-18 fluorodeoxyglucose uptake as a prognostic biomarker in newly diagnosed patients with locally advanced cervical cancer. Cancer. 2010;116(6):1469–75. https://doi.org/10.1002/cncr.24972.

    Article  PubMed  Google Scholar 

  34. Yen TC, See LC, Lai CH, Tsai CS, Chao A, Hsueh S, et al. Standardized uptake value in para-aortic lymph nodes is a significant prognostic factor in patients with primary advanced squamous cervical cancer. Eur J Nucl Med Mol Imaging. 2008;35(3):493–501. https://doi.org/10.1007/s00259-007-0612-1.

    Article  PubMed  Google Scholar 

  35. Yoo J, Choi JY, Moon SH, Bae DS, Bin PS, Choe YS, et al. Prognostic significance of volume-based metabolic parameters in uterine cervical cancer determined using 18F-fluorodeoxyglucose positron emission tomography. Int J Gynecol Cancer. 2012;22(7):1226–33. https://doi.org/10.1097/IGC.0b013e318260a905.

    Article  PubMed  Google Scholar 

  36. Lima GM, Matti A, Vara G, Dondi G, Naselli N, De Crescenzo EM, et al. Prognostic value of posttreatment 18F-FDG PET/CT and predictors of metabolic response to therapy in patients with locally advanced cervical cancer treated with concomitant chemoradiation therapy: an analysis of intensity- and volume-based PET parameters. Eur J Nucl Med Mol Imaging. 2018;45(12):2139–46. https://doi.org/10.1007/s00259-018-4077-1.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Kidd EA, Thomas M, Siegel BA, Dehdashti F, Grigsby PW. Changes in cervical cancer FDG uptake during chemoradiation and association with response. Int J Radiat Oncol Biol Phys. 2013;85(1):116–22. https://doi.org/10.1016/j.ijrobp.2012.02.056.

    Article  PubMed  Google Scholar 

  38. Schwarz JK, Siegel BA, Dehdashti F, Grigsby PW. Metabolic response on post-therapy FDG-PET predicts patterns of failure after radiotherapy for cervical cancer. Int J Radiat Oncol Biol Phys. 2012;83(1):185–90. https://doi.org/10.1016/j.ijrobp.2011.05.053.

    Article  PubMed  Google Scholar 

  39. Chong GO, Lee WK, Jeong SY, Park SH, Lee YH, Lee SW, et al. Prognostic value of intratumoral metabolic heterogeneity on F-18 fluorodeoxyglucose positron emission tomography/computed tomography in locally advanced cervical cancer patients treated with concurrent chemoradiotherapy. Oncotarget. 2017;8(52):90402–12. https://doi.org/10.18632/oncotarget.18769.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Grigsby PW, Siegel BA, Dehdashti F, Rader J, Zoberi I. Posttherapy [18F] fluorodeoxyglucose positron emission tomography in carcinoma of the cervix: response and outcome. J Clin Oncol. 2004;22(11):2167–71. d oi: 10.1200/JCO.2004.09.035

    Article  Google Scholar 

  41. Lai CH, Huang KG, See LC, Yen TC, Tsai CS, Chang TC, et al. Restaging of recurrent cervical carcinoma with dual-phase [18f]fluoro-2-deoxy-D-glucose positron emission tomography. Cancer. 2004;100(3):544–52. https://doi.org/10.1002/cncr.11928.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Section of Nuclear Medicine, University Department of Radiological Sciences and Haematology, Università Cattolica del Sacro Cuore, Rome, Italy

    Vanessa Feudo & Vittoria Rufini

  2. Nuclear Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

    Angela Collarino, Margherita Lorusso & Vittoria Rufini

  3. Unit of Gynecopathology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

    Damiano Arciuolo

  4. Institute of Obstetrics and Gynaecology, Università Cattolica del Sacro Cuore, Rome, Italy

    Gabriella Ferrandina

  5. Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

    Gabriella Ferrandina

Authors
  1. Vanessa Feudo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Angela Collarino
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Damiano Arciuolo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Margherita Lorusso
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Gabriella Ferrandina
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Vittoria Rufini
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Angela Collarino .

Editor information

Editors and Affiliations

  1. Nuclear Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

    Angela Collarino

  2. Nuclear Medicine, Hospital Clinic of Barcelona, Catalonia, Barcelona, Spain

    Sergi Vidal-Sicart

  3. Radiology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands

    Renato A. Valdés Olmos

Rights and permissions

Reprints and permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Feudo, V., Collarino, A., Arciuolo, D., Lorusso, M., Ferrandina, G., Rufini, V. (2022). Cervical Cancer. In: Collarino, A., Vidal-Sicart, S., Valdés Olmos, R.A. (eds) Nuclear Medicine Manual on Gynaecological Cancers and Other Female Malignancies. Springer, Cham. https://doi.org/10.1007/978-3-031-05497-6_3

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-05497-6_3

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-05496-9

  • Online ISBN: 978-3-031-05497-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation