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E2012. Cervical Cancer Case Series: Can You FIGO Out the Classification?
Authors
  1. Akram Sadeghi; Morristown Medical Center
  2. Derrick Tran; University of Oklahoma Health Sciences Center
  3. Karen Man; Morristown Medical Center
  4. Michael Prasad; Morristown Medical Center
  5. Stella Lam; Morristown Medical Center
Background
Cervical cancer is the fourth most common cancer in women worldwide. While cervical cancer screening is widely accessible and advancements such as human papilloma virus (HPV) vaccine programs have been developed in several nations, many young and middle-age women continue to be diagnosed throughout the world. Every year in the United States alone, 13,000 new cases are diagnosed, and 4,000 deaths occur as a consequence. Radiologists play a crucial role in determining appropriate management. Imaging guides treatment, from surgery to radiation to chemotherapy, and is crucial on follow-up for years to come. The complex anatomy of the pelvis can make the imaging diagnosis daunting. However, cervical cancer staging can be simplified by applying a stepwise approach to imaging.

Educational Goals / Teaching Points
This presentation will review cervical cancer staging using the International Federation of Gynecologic Oncology (FIGO) and Tumor, Node, Metastasis (TNM) systems. An overview of these two staging systems will be presented and how clinicians utilize these systems for their patients. Viewers will review the magnetic resonance (MR) imaging protocol for diagnosing cervical cancer, and review normal pelvic anatomy as it appears on these sequences. Using a case-based approach, viewers will then apply these concepts to cases collected from our institution. There will be special emphasis on resident education, with review of mimics, separating normal from abnormal, and formulating a differential diagnosis. Pearls and pitfalls are discussed in more challenging cases. Treatment options are highlighted for each case.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
MRI has quickly become the weapon of choice for radiologists to attack cervical cancer. Using high-resolution techniques and image processing algorithms, the complex anatomy of the pelvis can be simplified. Since the cervix is a small structure and composed of two morphologically distinct cell-types, large field of view imaging in orthogonal planes, coupled with magnified high-resolution images is essential to differentiating pathology. Separated by several important tissue planes, it lays in close proximity to neurovascular bundles and bowel. We present several patients between ages 34 to 90, and illustrate the characteristics of different imaging stages, including parametrial invasion, sidewall invasion, hydronephrosis, and urinary bladder and rectal involvement.

Conclusion
Cervical cancer is challenging to stage; however, with a solid foundation and knowledge of the imaging protocol and relevant clinical anatomy, radiologists are in the best position to care for these patients in coordination with their oncologists. This is an exciting time for the world of imaging, as new technologies and treatment options are being developed for an ever-increasing patient population afflicted by cervical cancer. However, with the right tools, streamlined treatment plans will lead to better patient outcomes and hopefully, make cervical cancer history.