16 Cervix Carcinoma

Cervix Cancer 303

Directly after the examination the findings are recorded by the examining physician on a specific form: height, width and length of the cervix and the tumor and its extension. This documentation includes a drawing of the pathologic anatomy in the frontal, sagittal and transverse planes. An individually made imprint provides precise, reliable and reproducible information about normal anatomy and tumour topography at the portio and in the vagina (see chapter 7.5) (13).

Fig 14.2: Bilateral Stage III B cervix cancer: A. Diagram of the clinical examination indicating width and thickness in different orientations.

In all cases a biopsy, or preferably punch biopsies, are systematically performed for histology. In order to assess location and the dimension of the uterus (cervix, corpus) and tumour (including tumour volume) precisely, sectional imaging is recommended. Transabdominal, transvaginal or preferably transrectal sonography and CT scan, help to check precisely the location and the dimension of the uterus and partly the gross tumour extension (32, 113,114,117). For orientation in the sagittal, coronal and transverse planes and for gross tumour delineation, MRI represents the method of choice (44,55,56,76,117). Sectional imaging methods, in particular CT and MRI, may also be used for assessing the topography of bladder, rectum, sigmoid, and intestine (31,113,114). Again, there is some advantage for MRI, as the discrimination of soft tissue structures is more accurate (44). CT scan or MRI are able to detect regional and/or distant lymph node metastases; in case of suspected lymph node involvement US/CT assisted fine needle biopsies can be taken. Recognizing the general difficulties in the assessment of lymphatic spread, laparoscopic approaches are being increasingly used to obtain better information about lymph node involvement and to better tailor the radiotherapy treatment strategy (21,43).