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Does a non-imaging gynecologic examination ensure a correct determination of the clinical stage in uterine cervical cancer? Based on a case study

Ryszard Krynicki1, Agnieszka Nalewczyńska1, Bogusław Lindner2, Jakub Pałucki3, Beata Śpiewankiewicz1

Affiliacja i adres do korespondencji
CURR. GYNECOL. ONCOL. 2014, 12 (2), p. 172–178
DOI: 10.15557/CGO.2014.0015
Streszczenie

The most common classification for uterine cervical cancer staging is based on the guidelines of the International Federation of Gynecology and Obstetrics (FIGO). A bimanual examination is performed in order to evaluate the clinical stage of uterine cervical cancer, and thus to select a treatment method. In the case of difficulties in performing the examination, such as increased tenderness, general anesthesia should be used. Imaging studies such as, for example, computed tomography (CT), ultrasound, magnetic resonance imaging (MRI) or PET-CT have not been incorporated into FIGO staging. One advantage of this classification is its applicability in any health center, although it is characterized by a rather high inconsistency with the actual state. The paper presents a case study of a patient diagnosed with uterine cervical cancer as well as the difficulty in assessing disease progression when based on FIGO classification. The patient was initially excluded from surgical treatment due to a palpable parametrial infiltration, which was later found to be imitated by a cyst containing some elements, most likely of bone origin, as revealed by a CT scan. Therefore, the patient received surgical treatment and subsequent chemoradiation. An incorrect FIGO-based assignment of the clinical stage in patients with uterine cervical cancer may lead to inappropriate therapeutic decisions, even in the setting of a multidisciplinary team with extensive experience. Therefore, it is necessary to perform imaging procedures, depending on the capabilities of a healthcare facility (abdominal and small pelvis MRI or CT), before reaching a final decision. When there are other accompanying pathological lesions present within the pelvis, the bimanual examination may fail to correctly assess cervical cancer progression.

Słowa kluczowe
cervical cancer, FIGO, gynecologic examination, MRI, imaging examination, CT