Cervical lymph node staging

Adult males given 500 mg Zn/kg ration, as ZnS04, for 6 weeks After 3 weeks, spermatogenesis was arrested at the primary spermatocyte stage. After 4 weeks, food consumption declined, forelimb lameness, and swelling in cervical lymph nodes. At 6 weeks, testes showed enlarged lumen and abnormal germinal epithelium. 20... 

A 54-year-old man with stage I folUcnlar Ijmphocytic lymphoma with cervical lymph nodes nnderwent splenectomy followed by chemotherapy with chlorambncil and had a partial response. Five months later, when he developed generalized lymphadenopathy and bone marrow involvement, he received fludarabine, cyclophosphamide, and ritnximab, with complete remission. Ten months later he developed a Merkel cell carcinoma involving the liver and lymph nodes. The disseminated tumor was chemoresistant and he died. His lymphoma remained in complete clinical remission throughout this time. 

For evaluation of the pelvic sidewall and lymph node staging, an additional proton-density or a Tl-weighted sequence in transverse orientation should be performed (see Fig. 7.11). The acquisition starts at the level of the aortic bifurcation and extends to below the pelvic floor. A slice thickness of 6 mm is used, with a 512 matrix and a phase resolution of at least 60%. Complete coverage of the inguinal lymph nodes should be attempted in patients with cervical cancers involving the lower third of the vagina (stage IIIA... 

Fig. 7.34a-d. Lymph node staging. Stages of metastatic spread to the lymph nodes in cervical cancer, a Parametrial nodes, b Nodes along the external and common iliac arteries, c Presacral nodes, d Para-aortic nodes (regarded as distant metastases) (from [134])... 

There exist no guidelines for the use of FDG PET in patients with cervical cancer. Studies investigating the use of whole-body FDG PET in cervical cancer demonstrated its diagnostic usefidness in lymph node staging... 

Hematogenous dissemination is rare and is seen only in advanced cervical cancer. The 10-year risk of distant metastases varies with the stage and ranges from 3% for IB cervical cancer and 75% for stage IVA. Preferred sites of distant metastases are the para-aor-tic and supraclavicular lymph nodes, the lungs, the abdominal cavity, and the skeleton [44]. 

Radiotherapy consists of external beam irradiation of the uninvolved pelvic lymphatics and uninvolved parametrial tissue with a dose of up to 45 Gy and intracavitary brachytherapy with three to six fractions of 4-8 Gy each dehvered to point A or the uterus [62], corresponding to a total dose equivalent of 70-80 Gy delivered to point A. The dose delivered by external beam radiotherapy is adjusted to the local tumor extent and metastatic nodal involvement (boost). A larger field of external irradiation is chosen in patients with para-aortic lymph node metastases. No brachytherapy is done in most patients with infiltration of the bladder or rectum because of the risk of fistula development. Alternatively, cervical cancer with invasion of adj acent pelvic organs can be treated by surgical pelvic exenteration. The most common therapies according to stage are summarized in Table 7.3. 

The imaging area should comprise not only the pelvis but also the abdomen up to the renal hilum in order to include the para-aortic lymph nodes. This applies especially to patients with cervical cancer stage IIB and above. 

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