| Abstract: |
Cervical cancer: About 12,200 new cases of cervical cancer were estimated in the USA in 2010. The overall 5-year survival for all stages is about 71%. At pathology 80–90% of cervical cancers are squamous cell carcinoma. Cervical cancer spreads by direct extension to local structures and regional lymphatics, with late hematogenous dissemination to distant organs (bone, brain, liver, lung). Cervical cancer is staged using the International Federation of Gynecology and Obstetrics (FIGO) system. Ultrasound, computed tomography, magnetic resonance imaging, and positron emission tomography are useful for evaluating the stage of disease. [18F]FDG PET-CT is more sensitive than CT or MRI for detecting local pelvic and distant lymph node involvement. However, [18F]FDG imaging cannot reliably detect micrometastases seen at histopathology. [18F]FDG PET is useful to localize recurrent disease. Endometrial cancer: About 43,000 new cases of endometrial cancer were estimated in the USA in 2010. Adenocarcinoma is the most common cell type. Invasion occurs into the myometrium, while distant spread of the tumor occurs through blood vessels or lymphatics. Surgical staging is definitive and nodal sampling is routinely performed. Clinical staging is commonly based on FIGO classification. Presurgical staging with [18F]FDG PET is useful in high-grade endometrial cancer to detect extrapelvic disease. However, [18F]FDG PET has a lower sensitivity for the detection of nodal disease. Ovarian cancer: About 22,000 new cases of ovarian cancer were estimated in the USA in 2010. The tumors generally arise from germinal epithelium. The most common histology is serious. The tumors are staged according to the FIGO classification. Although ultrasound is usually an initial imaging modality for detection and characterization of adnexal masses and pelvic ascites, CT is the imaging modality of choice for preoperative staging. MRI remains the best tool for evaluating pelvic sidewall invasion. Although most tumors show intense accumulation of [18F]FDG, the role of [18F]FDG PET in the primary diagnosis is limited. However, PET/CT can be useful as an adjunct to conventional imaging to detect previously unrecognized distant metastases. In recurrent ovarian cancer MRI is superior to CT in assessing the local extent of disease. [18F]FDG PET is a secondary imaging modality which can help detect disease in patients who are asymptomatic with rising CA-125. Lymphoscintigraphy for sentinel lymph node mapping is useful in vaginal, cervical, and endometrial cancer. Sentinel lymph node status offers prognostic information and assists in the decision for adjuvant therapy. Since the incidence of nodal metastasis is low in patients presenting with early-stage disease, sentinel lymph node evaluation may reduce the morbidity of surgery without compromising the identification of patients requiring adjuvant treatment. © Springer Science+Business Media New York 2013. |
