eMedicine Specialties > Radiology > Obstetrics/Gynecology

Cervix, Cancer: Multimedia

Author: Faysal A Saksouk, MD, Director of Body Imaging Fellowship and Section Chief of CT, Detroit Medical Center; Associate Professor of Radiology, Department of Radiology, Harper University Hospital, Wayne State University School of Medicine
Contributor Information and Disclosures

Updated: Jun 25, 2009

Multimedia

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Media file 1: Computed tomography scan of stage Ib carcinoma confined to the cervix (same patient in Images 1-2 in Multimedia). This image shows a mass with a slightly heterogeneous area of attenuation that expands the cervix and is surrounded by a thin rim of relatively preserved stroma. The cervical margins are smooth, well defined, and intact. Parametrial soft-tissue stranding or masses are lacking, and the periureteral fat planes are preserved.

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Computed tomography scan of stage Ib carcinoma confined to the cervix (same patient in Images 1-2 in Multimedia). This image shows a mass with a slightly heterogeneous area of attenuation that expands the cervix and is surrounded by a thin rim of relatively preserved stroma. The cervical margins are smooth, well defined, and intact. Parametrial soft-tissue stranding or masses are lacking, and the periureteral fat planes are preserved.

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Media file 2: Computed tomography scan through the upper uterus (same patient in Images 1-2 in Multimedia). This image shows fluid that markedly distends the endometrial cavity secondary to obstruction of the endocervical canal by cervical cancer. A small submucosal leiomyoma projects into the right anterior aspect of the endometrial cavity and has minute calcifications.

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Computed tomography scan through the upper uterus (same patient in Images 1-2 in Multimedia). This image shows fluid that markedly distends the endometrial cavity secondary to obstruction of the endocervical canal by cervical cancer. A small submucosal leiomyoma projects into the right anterior aspect of the endometrial cavity and has minute calcifications.

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Media file 3: Computed tomography scan of a large, lobulated mass that is replacing the cervix and showing nonuniform hypoattenuation. The air and fluid in the center of the mass are consistent with tumor necrosis and a complicating infection (the patient had purulent discharge). The central hypoattenuation in the uterine corpus is suggestive of minimal fluid in the cavity.

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Computed tomography scan of a large, lobulated mass that is replacing the cervix and showing nonuniform hypoattenuation. The air and fluid in the center of the mass are consistent with tumor necrosis and a complicating infection (the patient had purulent discharge). The central hypoattenuation in the uterine corpus is suggestive of minimal fluid in the cavity.

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Media file 4: Computed tomography (CT) scan of clinical stage IIb cervical carcinoma (same patient in Images 4-5 in Multimedia). The parametrial invasion is depicted with CT scanning as loss of definition of the cervical contours, accompanied by increased attenuation and prominent soft-tissue stranding in the parametrial fat. Parametritis can result in similar findings. The cervix shows ill-defined hypoattenuation, but the tumor is not clearly delineated.

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Computed tomography (CT) scan of clinical stage IIb cervical carcinoma (same patient in Images 4-5 in Multimedia). The parametrial invasion is depicted with CT scanning as loss of definition of the cervical contours, accompanied by increased attenuation and prominent soft-tissue stranding in the parametrial fat. Parametritis can result in similar findings. The cervix shows ill-defined hypoattenuation, but the tumor is not clearly delineated.

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Media file 5: Computed tomography (CT) scan of clinical stage IIb cervical carcinoma (same patient in Images 4-5 in Multimedia). The parametrial invasion is depicted with CT scanning as loss of definition of the cervical contours, accompanied by increased attenuation and prominent soft-tissue stranding in the parametrial fat. Parametritis can result in similar findings. The cervix shows ill-defined hypoattenuation, but the tumor is not clearly delineated. In addition, a subserosal leiomyoma protrudes from the left side of the uterus.

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Computed tomography (CT) scan of clinical stage IIb cervical carcinoma (same patient in Images 4-5 in Multimedia). The parametrial invasion is depicted with CT scanning as loss of definition of the cervical contours, accompanied by increased attenuation and prominent soft-tissue stranding in the parametrial fat. Parametritis can result in similar findings. The cervix shows ill-defined hypoattenuation, but the tumor is not clearly delineated. In addition, a subserosal leiomyoma protrudes from the left side of the uterus.

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Media file 6: Sagittal transabdominal sonogram of clinical stage IIb cervical carcinoma (same patient in Images 6-9 in Multimedia). This image shows a diffusely enlarged cervix with heterogeneous echogenicity. The tumor margins are not clearly delineated, and the parametrial invasion is not obvious.

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Sagittal transabdominal sonogram of clinical stage IIb cervical carcinoma (same patient in Images 6-9 in Multimedia). This image shows a diffusely enlarged cervix with heterogeneous echogenicity. The tumor margins are not clearly delineated, and the parametrial invasion is not obvious.

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Media file 7: Transverse transabdominal sonogram of clinical stage IIb cervical carcinoma (same patient in Images 6-9 in Multimedia). This image shows a diffusely enlarged cervix with heterogeneous echogenicity. The tumor margins are not clearly delineated, and the parametrial invasion is not obvious.

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Transverse transabdominal sonogram of clinical stage IIb cervical carcinoma (same patient in Images 6-9 in Multimedia). This image shows a diffusely enlarged cervix with heterogeneous echogenicity. The tumor margins are not clearly delineated, and the parametrial invasion is not obvious.

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Media file 8: Computed tomography (CT) scan of clinical stage IIb cervical carcinoma (same patient in Images 6-9 in Multimedia). This image shows a hypoattenuating tumor occupying the entire cervix and extending to the outer posterior and right cervical margins. This finding is consistent with full-thickness stromal invasion. Minimal air in the center is related to the biopsy. A vaginal tampon is present to the right of the cervix.

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Computed tomography (CT) scan of clinical stage IIb cervical carcinoma (same patient in Images 6-9 in Multimedia). This image shows a hypoattenuating tumor occupying the entire cervix and extending to the outer posterior and right cervical margins. This finding is consistent with full-thickness stromal invasion. Minimal air in the center is related to the biopsy. A vaginal tampon is present to the right of the cervix.

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Media file 9: Computed tomography (CT) scan of clinical stage IIb cervical carcinoma (same patient in Images 6-9 in Multimedia). Parametrial invasion is depicted with CT scanning as loss of definition of the cervical contours, accompanied by soft-tissue attenuation that replaces the periureteral fat on the right.

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Computed tomography (CT) scan of clinical stage IIb cervical carcinoma (same patient in Images 6-9 in Multimedia). Parametrial invasion is depicted with CT scanning as loss of definition of the cervical contours, accompanied by soft-tissue attenuation that replaces the periureteral fat on the right.

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Media file 10: Computed tomography (CT) scan of parametrial and rectal invasion by cervical carcinoma (same patient in Images 10-11 in Multimedia). There is loss of definition of the cervical contours, accompanied by a masslike soft tissue that replaces the parametrial fat on the right and that extends into the anterior and right-sided rectal walls.

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Computed tomography (CT) scan of parametrial and rectal invasion by cervical carcinoma (same patient in Images 10-11 in Multimedia). There is loss of definition of the cervical contours, accompanied by a masslike soft tissue that replaces the parametrial fat on the right and that extends into the anterior and right-sided rectal walls.

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Media file 11: Computed tomography (CT) scan of parametrial and rectal invasion by cervical carcinoma (same patient in Images 10-11 in Multimedia). There is loss of definition of the cervical contours, accompanied by a masslike soft tissue that replaces the parametrial fat on the right side. The cervix is diffusely enlarged and shows subtle hypoattenuation, but the tumor margins are not clearly delineated.

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Computed tomography (CT) scan of parametrial and rectal invasion by cervical carcinoma (same patient in Images 10-11 in Multimedia). There is loss of definition of the cervical contours, accompanied by a masslike soft tissue that replaces the parametrial fat on the right side. The cervix is diffusely enlarged and shows subtle hypoattenuation, but the tumor margins are not clearly delineated.

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Media file 12: This computed tomography scan demonstrates a markedly enlarged lymph node at the left pelvic sidewall, a finding that is consistent with pelvic lymph node metastasis, which is indicative of stage IIIb disease. The cystic consistency is not unusual for metastatic cervical carcinoma. The primary tumor is well depicted as a hypoattenuating, circumscribed mass. A cyst is present in the anteriorly located left ovary.

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This computed tomography scan demonstrates a markedly enlarged lymph node at the left pelvic sidewall, a finding that is consistent with pelvic lymph node metastasis, which is indicative of stage IIIb disease. The cystic consistency is not unusual for metastatic cervical carcinoma. The primary tumor is well depicted as a hypoattenuating, circumscribed mass. A cyst is present in the anteriorly located left ovary.

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Media file 13: This computed tomography scan demonstrates a cervical tumor directly extending into the posterior wall of the bladder and into the left pelvic sidewall. Extension into the pelvic sidewall is a feature of stage IIIb disease, whereas involvement of the bladder wall is a feature of stage IVa disease.

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This computed tomography scan demonstrates a cervical tumor directly extending into the posterior wall of the bladder and into the left pelvic sidewall. Extension into the pelvic sidewall is a feature of stage IIIb disease, whereas involvement of the bladder wall is a feature of stage IVa disease.

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Media file 14: Computed tomography (CT) scan of stage IVb cervical carcinoma (same patient in Images 14-17 in Multimedia). There is the presence of borderline enlarged para-aortic and pelvic lymph nodes, presumably secondary to metastasis; left hydronephrosis and hydroureter to the level of the large cervical tumor; and direct intraluminal extension of the tumor into the bladder. The borderline enlarged left para-aortic lymph node is consistent with stage IVb cervical carcinoma.

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Computed tomography (CT) scan of stage IVb cervical carcinoma (same patient in Images 14-17 in Multimedia). There is the presence of borderline enlarged para-aortic and pelvic lymph nodes, presumably secondary to metastasis; left hydronephrosis and hydroureter to the level of the large cervical tumor; and direct intraluminal extension of the tumor into the bladder. The borderline enlarged left para-aortic lymph node is consistent with stage IVb cervical carcinoma.

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Media file 15: Computed tomography (CT) scan of stage IVb cervical carcinoma (same patient in Images 14-17 in Multimedia). There is the presence of borderline enlarged para-aortic and pelvic lymph nodes, presumably secondary to metastasis; left hydronephrosis and hydroureter to the level of the large cervical tumor; and direct intraluminal extension of the tumor into the bladder. The left hydronephrosis is a feature of stage IIIb disease.

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Computed tomography (CT) scan of stage IVb cervical carcinoma (same patient in Images 14-17 in Multimedia). There is the presence of borderline enlarged para-aortic and pelvic lymph nodes, presumably secondary to metastasis; left hydronephrosis and hydroureter to the level of the large cervical tumor; and direct intraluminal extension of the tumor into the bladder. The left hydronephrosis is a feature of stage IIIb disease.

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Media file 16: Computed tomography (CT) scan of stage IVb cervical carcinoma (same patient in Images 14-17 in Multimedia). There is the presence of borderline enlarged para-aortic and pelvic lymph nodes, presumably secondary to metastasis; left hydronephrosis and hydroureter to the level of the large cervical tumor; and direct intraluminal extension of the tumor into the bladder. The borderline pelvic lymph node enlargement and left hydroureter are features of stage IIIb disease. The cervical tumor likely extends into the upper uterus.

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Computed tomography (CT) scan of stage IVb cervical carcinoma (same patient in Images 14-17 in Multimedia). There is the presence of borderline enlarged para-aortic and pelvic lymph nodes, presumably secondary to metastasis; left hydronephrosis and hydroureter to the level of the large cervical tumor; and direct intraluminal extension of the tumor into the bladder. The borderline pelvic lymph node enlargement and left hydroureter are features of stage IIIb disease. The cervical tumor likely extends into the upper uterus.

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Media file 17: Computed tomography (CT) scan of stage IVb cervical carcinoma (same patient in Images 14-17 in Multimedia). There is the presence of borderline enlarged para-aortic and pelvic lymph nodes, presumably secondary to metastasis; left hydronephrosis and hydroureter to the level of the large cervical tumor; and direct intraluminal extension of the tumor into the bladder. Direct intraluminal extension of the tumor into the bladder is a feature of stage IVa tumors.

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Computed tomography (CT) scan of stage IVb cervical carcinoma (same patient in Images 14-17 in Multimedia). There is the presence of borderline enlarged para-aortic and pelvic lymph nodes, presumably secondary to metastasis; left hydronephrosis and hydroureter to the level of the large cervical tumor; and direct intraluminal extension of the tumor into the bladder. Direct intraluminal extension of the tumor into the bladder is a feature of stage IVa tumors.

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Media file 18: Sagittal T2-weighted magnetic resonance image (MRI) of stage Ib cervical cancer (same patient in Images 18-19 in Multimedia). This MRI shows a circumscribed, hyperintense mass in the posterior lip of the cervix that is associated with intact peripheral cervical margins and an intact parametrium. These are features of cancer that is confined to the cervix (stage Ib). Courtesy of Kaori Togashi, MD, Hitachi Medical Corporation, Chair of Department of Diagnostic and Interventional Imageology, Kyoto University, Japan.

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Sagittal T2-weighted magnetic resonance image (MRI) of stage Ib cervical cancer (same patient in Images 18-19 in Multimedia). This MRI shows a circumscribed, hyperintense mass in the posterior lip of the cervix that is associated with intact peripheral cervical margins and an intact parametrium. These are features of cancer that is confined to the cervix (stage Ib). Courtesy of Kaori Togashi, MD, Hitachi Medical Corporation, Chair of Department of Diagnostic and Interventional Imageology, Kyoto University, Japan.

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Media file 19: Axial T2-weighted magnetic resonance image (MRI) of stage Ib cervical cancer (same patient in Images 18-19 in Multimedia). This MRI shows a hyperintense tumor in the posterior lip of the cervix. There is segmental disappearance of the right lateral and posterior aspects of the hypointense stromal stripe or ring, which is consistent with localized, deep stromal invasion. However, the tumor is fairly sharply marginated, does not protrude beyond the stromal ring, and the parametrium is intact. These are features of cancer that is confined to the cervix (stage Ib). Courtesy of Kaori Togashi, MD, Hitachi Medical Corporation, Chair of Department of Diagnostic and Interventional Imageology, Kyoto University, Japan.

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Axial T2-weighted magnetic resonance image (MRI) of stage Ib cervical cancer (same patient in Images 18-19 in Multimedia). This MRI shows a hyperintense tumor in the posterior lip of the cervix. There is segmental disappearance of the right lateral and posterior aspects of the hypointense stromal stripe or ring, which is consistent with localized, deep stromal invasion. However, the tumor is fairly sharply marginated, does not protrude beyond the stromal ring, and the parametrium is intact. These are features of cancer that is confined to the cervix (stage Ib). Courtesy of Kaori Togashi, MD, Hitachi Medical Corporation, Chair of Department of Diagnostic and Interventional Imageology, Kyoto University, Japan.

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Media file 20: Sagittal T2-weighted magnetic resonance image (MRI) of stage IIb cervical cancer with anterior parametrial and anterior vaginal fornix invasion (same patient in Images 20-21 in Multimedia). This MRI shows a slightly hyperintense cervical tumor disrupting the hypointense stromal stripe, extending anteriorly through the disrupted vaginal fornix, and involving the anterior parametrium. The endometrial cavity is distended by fluid. Courtesy of Kaori Togashi, MD, Hitachi Medical Corporation, Chair of Department of Diagnostic and Interventional Imageology, Kyoto University, Japan.

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Sagittal T2-weighted magnetic resonance image (MRI) of stage IIb cervical cancer with anterior parametrial and anterior vaginal fornix invasion (same patient in Images 20-21 in Multimedia). This MRI shows a slightly hyperintense cervical tumor disrupting the hypointense stromal stripe, extending anteriorly through the disrupted vaginal fornix, and involving the anterior parametrium. The endometrial cavity is distended by fluid. Courtesy of Kaori Togashi, MD, Hitachi Medical Corporation, Chair of Department of Diagnostic and Interventional Imageology, Kyoto University, Japan.

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Media file 21: Axial T2-weighted magnetic resonance image (MRI) of stage IIb cervical cancer with anterior parametrial and anterior vaginal fornix invasion (same patient in Images 20-21 in Multimedia). This MRI shows a slightly hyperintense cervical tumor disrupting the hypointense stromal stripe and protruding anteriorly beyond the cervical margin into the parametrium. Courtesy of Kaori Togashi, MD, Hitachi Medical Corporation, Chair of Department of Diagnostic and Interventional Imageology, Kyoto University, Japan.

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Axial T2-weighted magnetic resonance image (MRI) of stage IIb cervical cancer with anterior parametrial and anterior vaginal fornix invasion (same patient in Images 20-21 in Multimedia). This MRI shows a slightly hyperintense cervical tumor disrupting the hypointense stromal stripe and protruding anteriorly beyond the cervical margin into the parametrium. Courtesy of Kaori Togashi, MD, Hitachi Medical Corporation, Chair of Department of Diagnostic and Interventional Imageology, Kyoto University, Japan.

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Media file 22: Sagittal T2-weighted magnetic resonance image (MRI) of a large cervical tumor extending through the entire cervical stroma and extensively involving the uterine corpus, vagina, bladder wall, and posterior urethral region (same patient in Images 22-23 in Multimedia). The invasion of the bladder wall is a feature of stage IVa disease. Courtesy of Kaori Togashi, MD, Hitachi Medical Corporation, Chair of Department of Diagnostic and Interventional Imageology, Kyoto University, Japan.

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Sagittal T2-weighted magnetic resonance image (MRI) of a large cervical tumor extending through the entire cervical stroma and extensively involving the uterine corpus, vagina, bladder wall, and posterior urethral region (same patient in Images 22-23 in Multimedia). The invasion of the bladder wall is a feature of stage IVa disease. Courtesy of Kaori Togashi, MD, Hitachi Medical Corporation, Chair of Department of Diagnostic and Interventional Imageology, Kyoto University, Japan.

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Media file 23: Axial T2-weighted magnetic resonance image (MRI) of a large cervical tumor with full-thickness stromal invasion causing complete loss of the hypointense stromal stripe or ring (same patient in Images 22-23 in Multimedia). Also depicted is invasion of the parametrium and the posterior bladder wall; this finding is indicative of stage IVa disease. Courtesy of Kaori Togashi, MD, Hitachi Medical Corporation, Chair of Department of Diagnostic and Interventional Imageology, Kyoto University, Japan.

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Axial T2-weighted magnetic resonance image (MRI) of a large cervical tumor with full-thickness stromal invasion causing complete loss of the hypointense stromal stripe or ring (same patient in Images 22-23 in Multimedia). Also depicted is invasion of the parametrium and the posterior bladder wall; this finding is indicative of stage IVa disease. Courtesy of Kaori Togashi, MD, Hitachi Medical Corporation, Chair of Department of Diagnostic and Interventional Imageology, Kyoto University, Japan.

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Media file 24: This sagittal transabdominal sonogram shows a circumscribed hypoechoic tumor in the posterior aspect of the cervix (same patient as Images 24-26 in Multimedia).

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This sagittal transabdominal sonogram shows a circumscribed hypoechoic tumor in the posterior aspect of the cervix (same patient as Images 24-26 in Multimedia).

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Media file 25: This transverse transvaginal sonogram shows a circumscribed hypoechoic tumor in the left posterior aspect of the cervix (same patient in Images 24-26 in Multimedia).

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This transverse transvaginal sonogram shows a circumscribed hypoechoic tumor in the left posterior aspect of the cervix (same patient in Images 24-26 in Multimedia).

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Media file 26: This sagittal transvaginal color Doppler sonogram shows prominent vascular flow in the cervical tumor (same patient in Images 24-26 in Multimedia).

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This sagittal transvaginal color Doppler sonogram shows prominent vascular flow in the cervical tumor (same patient in Images 24-26 in Multimedia).

More on Cervix, Cancer

Overview: Cervix, Cancer

Imaging: Cervix, Cancer

Follow-up: Cervix, Cancer

Multimedia: Cervix, Cancer

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Keywords

cancer of the cervix, cervical cancer, cervical adenocarcinoma, carcinoma of the cervix uteri, squamous cell carcinoma of the cervix uteri, epidermoid carcinoma of the cervix uteri, adenocarcinoma of the cervix uteri, cervical malignancy, uterine neoplasms, tumors of the cervix, cervical tumors, cervical neoplasms, human papillomavirus, papillomavirus, HPV, cervical intraepithelial neoplasia, CIN

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Faysal A Saksouk, MD, Director of Body Imaging Fellowship and Section Chief of CT, Detroit Medical Center; Associate Professor of Radiology, Department of Radiology, Harper University Hospital, Wayne State University School of Medicine
Faysal A Saksouk, MD is a member of the following medical societies: American College of Radiology, American Roentgen Ray Society, and Radiological Society of North America
Disclosure: Nothing to disclose.

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Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
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Karen L Reuter, MD, FACR, Professor, Department of Radiology, Lahey Clinic Medical Center
Karen L Reuter, MD, FACR is a member of the following medical societies: American Association for Women Radiologists, American College of Radiology, American Institute of Ultrasound in Medicine, American Roentgen Ray Society, and Radiological Society of North America
Disclosure: Nothing to disclose.

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Robert M Krasny, MD, Consulting Staff, Department of Radiology, Resolution Imaging Medical Corporation
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

Eugene C Lin, MD, Consulting Radiologist, Virginia Mason Medical Center; Clinical Assistant Professor of Radiology, University of Washington School of Medicine
Eugene C Lin, MD is a member of the following medical societies: American College of Nuclear Medicine, American College of Radiology, Radiological Society of North America, and Society of Nuclear Medicine
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eMedicine Specialties > Radiology > Obstetrics/Gynecology

Cervix, Cancer: Multimedia

Multimedia

Sagittal transabdominal sonogram of clinical stage IIb cervical carcinoma (same patient in Images 6-9 in Multimedia). This image shows a diffusely enlarged cervix with heterogeneous echogenicity. The tumor margins are not clearly delineated, and the parametrial invasion is not obvious.

Transverse transabdominal sonogram of clinical stage IIb cervical carcinoma (same patient in Images 6-9 in Multimedia). This image shows a diffusely enlarged cervix with heterogeneous echogenicity. The tumor margins are not clearly delineated, and the parametrial invasion is not obvious.

This computed tomography scan demonstrates a cervical tumor directly extending into the posterior wall of the bladder and into the left pelvic sidewall. Extension into the pelvic sidewall is a feature of stage IIIb disease, whereas involvement of the bladder wall is a feature of stage IVa disease.

This sagittal transabdominal sonogram shows a circumscribed hypoechoic tumor in the posterior aspect of the cervix (same patient as Images 24-26 in Multimedia).

This transverse transvaginal sonogram shows a circumscribed hypoechoic tumor in the left posterior aspect of the cervix (same patient in Images 24-26 in Multimedia).

This sagittal transvaginal color Doppler sonogram shows prominent vascular flow in the cervical tumor (same patient in Images 24-26 in Multimedia).

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