Target Volume Determination 2015

NODAL DISEASE : ANATOMY Within the pelvis, cervical cancer spreads first to parametrial nodes, then to obturator, internal and external iliac nodes. In more advanced disease, common iliac and para-aortic nodes may be involved. Although not incorporated in the FIGO staging system, presence of lymph node metastases has significant prognostic and treatment consequences. The 5-year survival for node positive patients is 39-54% compared with 67-92% in patients without nodal involvement . In early stage tumour, involvement of any node is important as it excludes curative surgery changing the treatment to either chemoradiotherapy alone, or debulking surgery and neo-adjuvant chemoradiotherapy. In advanced tumours, detection of para-aortic nodes is important for planning the extent of the radiation field.