Is a PET scan needed to stage my relative’s cervical cancer?

Question

Hi doctor,

My query is regarding my relative who is suffering from carcinoma of the cervix. I would kindly request you to advise us regarding the stage of cancer based on the biopsy, MRI, and CT scan reports, 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.

The CT scan gives an impression of a 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 getting a vaginal examination done. Is a PET scan necessary in this case to get a clearer view than a CT scan?

Kindly guide us.

Thank you.

Answer 1

Hi,

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. She has cervical carcinoma. 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. 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 has spread to the distant organs.

Thus, it shows the lung metastasis. It falls into stage IV of cervical cancer. Consult her treating physician for clinical correlation, as it is very important, since I do not have the complete case in front of me. No need for a PET scan in this case. Vagina is normal on the MRI of the pelvis, so no need to worry about vaginal examination.

I hope this information helps you.

Thank you.

Answer 2

Hi,

Welcome back to icliniq.com.

If she wishes to go for a 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. A PET scan works on glucose uptake and usage by the body cells. In this procedure, we inject glucose into a vein and see the glucose usage.

Normal cells absorb glucose normally, but tumor cells, being overactive, take glucose rapidly. On the test screen, their metabolism will be rapid, bright, and dark-colored. This will help in detecting if the cancer cells have spread to the vagina, uterus, and other nearby structures.

It will also confirm if the nodules in the 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 the lungs.

I hope this helps.

Please feel free to reach out in case of any further queries.

Thank you.