Carcinoma della cervice uterina

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Priscilla Austin
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1 Carcinoma della cervice uterina 16/01/2018 Carpi Dott. Matteo Generali U.O. Ginecologia

Epidemiology Second most common malignancy in women worlwide CASI: 493.293 DECESSI: 273.

2 Epidemiology Second most common malignancy in women worlwide CASI: DECESSI: In Italy, new cases /year CASI: DECESSI: IARC: incidence, mortality and prevalence of cervical cancer

3 Epidemiologia

Aetiology and risk factor Invasive cervical cancer is related to age, with a

The major cause of cervical cancer is infection with high-risk human

The role of human papillomavirus in the cause of cervical cancer is tightly

4 Aetiology and risk factor Invasive cervical cancer is related to age, with a mean age of 47 years at diagnosis in the USA. The major cause of cervical cancer is infection with high-risk human papillomavirus. The role of human papillomavirus in the cause of cervical cancer is tightly correlated with over-expression of two oncogenes (E6 and E7); Other risk factors are represented by : early onset of sexual activity, multiple sexual partners, cigarette smoking.

The initial choice of treatment largely depends on the cancer

Surgery Chemotp RT Progress in therapeutic strategies allows

5 The initial choice of treatment largely depends on the cancer stage at the time of diagnosis. Surgery Chemotp RT Progress in therapeutic strategies allows tailoring of treatment: women with advanced disease will require neoadjuvant treatment (e.g. radiotherapy or chemotherapy alone or combined) possibly followed by surgery. In early disease, minimally invasive surgery is possible.

6 Staging

11 Staging (imaging techniques)

12 ULTRASOUND Accuracy 94% Sensitivity 94% Specificity 97% Fischerova D et al Int J Gynecol Cancer 2008;18: Testa AC et al Ultrasound Obstet Gynecol 2009;34: Epstein E et al Ultrasound Obstet Gynecol 2010;36: Gaurilcikas A et al Ultrasound Obstet Gynecol 2011;38: Epstein E et algynecol Oncol 2013;128:

13 ULTRASOUND

14 ULTRASOUND

15 US assessment of cervical cancer

16 Ultrasound and morphological appearance of cervical cancer solid lesion mostly hypoechoic compared with the surrounding cervical stroma

17 Ultrasound and morphological appearance of cervical cancer

18 mostly hypoechoic mostly isoechoic

19 Less frequent appareance

20 Shape appearance

21 Disease extension assessment

22 Tumor and pericervical fascia PCF

24 Internal os distance

25 Cervical Stroma invasion

26 Parametrial extension

Parametrial extension In the presence of cervical cancer infiltrating the full thickness of the cervical stroma, the extension into the anterior, posterior, and lateral parametria has to be assessed.

27 Parametrial extension In the presence of cervical cancer infiltrating the full thickness of the cervical stroma, the extension into the anterior, posterior, and lateral parametria has to be assessed. The anterior compartment includes the bladderwall, vesico-vaginal septum, and anterior parametria (thin hyperecoic tissue located laterally to vesico-vaginal septum at longitudinal section through the pelvis). The lateral parametria correspond to the tissue located laterally to the cervix (paracervix). The posterior compartment includes the rectum, recto-vaginal septum, posterior parametria (uterosacral ligaments)

29 Parametrial extension

34 Extrauterine disease Normal lymph node

35 Extrauterine disease Infiltrated lymph node

36 Extrauterine disease

a small amount of nearly anechoic fluid or mucus centrally.

38 Test The echogenic central line represents the interface between the two mucosal layers. The endocervical canal is lined by a glandular area (white arrows) that usually measures 2 4 mm in single-layer thickness and may contain a small amount of nearly anechoic fluid or mucus centrally. The glandular area ranges from hypoechoic (in a) to isoechoic or slightly hyperechoic (in b) relative to the cervical stroma. Cervical stroma is typically similar in echogenicity to myometrium and may demonstrate a narrow hypoechoic submucosal zone (arrowheads).

39 Test The plicae palmatae appear as serrations in the mucosa due to compact folds

41 21-year-old woman with reported bumps in the genital region

stroma Coronal gray-scale endovaginal US image shows an echogenic

42 Typical appearance of nabothian cysts: multiple anechoic cystic structures in the endocervical mucosa, some of which extend into the stroma Coronal gray-scale endovaginal US image shows an echogenic nabothian cyst without shadowing (arrow), reflecting proteinaceous or crystalline content

43 Coronal gray-scale endovaginal US image shows the multicystic appearance of the cervix due to conglomerated nabothian cysts, which sometimes mimics the appearance of a multicystic mass.

internal vascularity, a finding thought to represent a

44 Sagittal gray-scale and spectral Doppler endovaginal US images show a complex hypoechoic mass (M) with no detectable internal vascularity, a finding thought to represent a hemorrhagic nabothian cyst. Note the adjacent small simple nabothian cysts

centered in the cervical stroma, a typical appearance for a leiomyoma Because fewer than 10% of all uterine leiomyomas arise

45 Cervical lesion in a 35-year-old woman with vaginal spotting in the first trimester of pregnancy. Parasagittal gray-scale endovaginal US image to the right of midline shows a well-circumscribed hypoechoic mass (arrow) centered in the cervical stroma, a typical appearance for a leiomyoma Because fewer than 10% of all uterine leiomyomas arise in the cervix, care must be taken to determine that a visualized leiomyoma in the cervical region is not a cancer or prolapsing leiomyoma from the uterine cavity

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