Q. Is PET scan a must to identify the stage of cancer?

Answered by
Dr. Muhammad Majid Hanif
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Apr 07, 2016 and last reviewed on: Jan 18, 2020

Hi doctor,

My query is regarding my relative who is suffering from carcinoma of cervix. I would kindly request you to advise us regarding the stage of cancer based on the biopsy, MRI and CT scan report which I have attached here for your reference. In her MRI report, there is a feature suggestive of carcinoma of the cervix with parametrial extension. In CT scan it gives an impression of bulky cervix with parametrial fat stranding along with a few subcentimeter sized parenchymal and subpleural nodes in the bilateral lower lobes. I would like to know whether the above mentioned reports are sufficient to identify the stage of cancer? She even advised to get vaginal examination done. Is a PET scan necessary in this case in order to get a clear view than CT scan? Kindly guide us.



Welcome to icliniq.com.

I would like to assure you that everything is going to be fine soon. I have thoroughly gone through your case and the reports (attachment removed to protect patient identity) and can well understand your genuine concerns.

The Probable causes:

1. She has got cervical carcinoma.
2. It is a well differentiated type of adenocarcinoma that is an invasive cancer. This is a less common type of cancer compared to the squamous carcinoma.
3. According to the staging systems devised for cervical cancers (AJCC-American Joint Committee on Cancer, TNM- tumor, lymph node and metastasis and FIGO - International Federation of Gynecology and Obstetrics), the tumor in this patient had spread to the distant organs. Thus it shows the lung metastasis.
4. It falls into stage IV of the cervical cancer.
5. Consult her treating physician for clinical correlation as it is very important, since I do not have the complete case in front of me.

Investigations to be done:

1. No need of PET scan in this case.
2. Vagina is normal on MRI of pelvis, so no need to worry for vaginal examination.

Regarding follow up:

For further queries consult an internal medicine physician online.--->https://www.icliniq.com/ask-a-doctor-online/internal-medicine-physician

Thank you doctor,

As you have mentioned that it has fallen to stage IV, I would like to know whether it is curable or not. We are planning to get the PET scan done based on doctor's opinion, in order to get more clarity whether it belongs to stage IV or II B stage. Please advise us as your feedback will be valuable for us.



Welcome back to icliniq.com.

If she wishes to go for PET scan, then please proceed. It is usually good to go for all tests before the start of treatment. But, sometimes we need to start the treatment first and then complete other tests. PET scan works on the principal of glucose uptake and usage by the body cells. In this procedure, we inject glucose in a vein and see the glucose usage. Normal cells absorb glucose normally, but tumor cells being over active take glucose rapidly.

On test screen, their metabolism will be rapid, bright and dark colored. This will help in detecting if the cancer cells have spread to vagina, uterus and other nearby structures. It will also confirm if the nodules in lungs are actually metastatic cancer cells or something else. This will be helpful in categorizing the staging too.

According to my knowledge it is of T2b cancer stage in TNM type staging and in FIGO staging, cancer is of stage IIB. It has parametrial invasion. If the lung lesions are cancer spread then T4b according to TNM or stage IVB according to FIGO. When we see regional lymph node studies, there is no lymph node spread and M1 if it has spread to distant organs such as lungs.

For further information consult an internal medicine physician online --> https://www.icliniq.com/ask-a-doctor-online/internal-medicine-physician

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