The role of PET/CT in the management of cervical cancer

Learning Objectives 1. Describe the management of cervical cancer.2. Describe the role of PET/CT in the management of cervical cancer.

Summary: Cervical cancer is the second most common cause of cancer death in women in the world but is less common in the United States. This cancer is associated with human papillomavirus infection. Squamous cell carcinoma is the most common tissue type with adenocarcinoma, adenosquamous carcinoma, and neuroendocrine cancers less common. Cervical cancer may spread to pelvic, paraortic, and supraclavicular lymph nodes. Hematogenous metastases are less likely. The management of early stage cervical cancer is conization or radical hysterectomy with or without adjuvant therapy or definitive radiotherapy. For patients with locally advanced disease the treatment is chemoradiation. Disseminated disease is treated with palliative radiotherapy and chemotherapy. Cervical cancer is typically metabolically active and PET/CT is therefore of value in staging. Accurate staging is important since the stage of the disease determines the therapy. PET/CT may detect disease in a metabolically active nonenlarged lymph node. PET/CT is also useful in restaging in identifying recurrent disease and has been reported to have an accuracy of 92% compared to the accuracy of CT or MR of 60%. PET/CT has been shown to be useful post treatment in determining whether findings represent tumor or scar. Accuracy is improved when PET/CT imaging is done six weeks after chemoradiation or twelve weeks after radiation therapy alone. Examples illustrating the role of PET/CT in the management of cervical cancer are provided.