Imaging and cancer of the cervix in low- and middle-income countries

Abstract

Cervix cancer is the fourth most common cancer globally but the second most cancer in women in resource-limited countries. It has remained a clinically-staged neoplasm as per the International Federation of Gynecology and Obstetrics staging classification. As the imaging machines are becoming more available worldwide, the resource-stratified guidelines recommended the inclusion of imaging whenever possible to guide treatment planning. In this report, the utility of imaging in low- and middle-income countries for diagnosis and treatment of cancer of the cervix will be reviewed.

Keywords: Cervical cancer; Computed tomography; Low and middle-income countries; Staging; Ultrasound.

Fig. 1

a. Cervical Carcinoma Transabdominal US sagittal view of the uterus in a 38 year old female with dysfunctional uterine bleeding demonstrates nonspecific enlargement of the cervix consistent with cervical carcinoma (black arrows). b. Transvaginal sagittal view of the same patient in 1A shows a better delineated hypoechoic mass (white arrows) expanding the cervix consistent with cervical carcinoma.

Fig. 2

Color Doppler Evaluation of Cervical Carcinoma Transverse transvaginal view of the cervix in a 43 year old woman with cervical carcinoma demonstrates diffusely increased color flow throughout the heterogeneously enlarged cervix (white arrows).

Fig. 3

Cervical Carcinoma Axial contrast-enhanced CT image in a 53 year old female with profuse vaginal bleeding and clinically palpable cervical mass shows marked, heterogeneous enlargement of the cervix (black arrows). A rim of increased attenuation is noted along the left anterolateral aspect of the mass (white arrow).

Fig. 4

Cervical Carcinoma Transabdominal sagittal view of the uterus shows diffuse, echogenic enlargement of the cervix (black arrows), consistent with cervical carcinoma. Diffuse, echogenic expansion of the vaginal fornices (*) are likewise noted, consistent with tumoral involvement of the proximal vagina.

Fig. 5

Locally Invasive Cervical Carcinoma Coronal oblique contrast-enhanced CT image shows diffuse, heterogeneous enlargement of the cervix (*). Diffusely decreased, heterogeneous attenuation is seen throughout the uterine corpus with distortion of the endometrial cavity (white arrow), consistent with tumoral infiltration of both endometrium and myometrium. Nodular, soft-tissue stranding is seen within the parametrium (black arrows), consistent with parametrial extension of tumor.

Fig. 6

Locally Invasive Cervical Carcinoma Coronal contrast-enhanced CT shows a large, heterogeneous mass arising from the cervix (black *). Extensive tumoral infiltration of the right pelvic side wall is noted (white arrow). Bilateral hydronephrosis is seen (white *) as a result of tumoral encasement of the distal ureters.

Fig. 7

Cervical Carcinoma with Bladder Wall Invasion Axial contrast-enhanced CT shows a poorly marginated, heterogeneous cervical mass (*) that is inseparable from the right posterolateral bladder wall, consistent local bladder wall invasion.

Fig. 8

Cervical Carcinoma with Retroperitoneal Lymphadenopathy Coronal contrast-enhanced image of a 57 year old female with metastatic cervical carcinoma shows bulky, confluent retroperitoneal aortocaval and para-aortic lymphadenopathy (white arrows).

Fig. 9

Metastatic Cervical Cancer with Liver Metastases Axial contrast-enhanced CT of the abdomen in a patient with widely metastatic cervical carcinoma shows several ill-defined, poorly marginated masses within the inferior right lobe (black arrow) consistent with liver metastases.

Fig. 10

Cervical Carcinoma with Osseous Metastases Coronal CT in a 37 year old female with widely metastatic cervical carcinoma shows lytic, destructive changes of the right acetabulum and inferior pubic ramus (white arrow). A right nephroueteral stent is partially visualized due to tumoral infiltration of the right collecting system.