Department of Senological, Gynecological, Plastic and Reconstructive Surgery - Paris Professor Fabrice Lecuru - Institut Curie
  • Cervix Cancer

    Diagnosis

    Ideally, the diagnosis of cervical cancer should be made at an early stage, before the appearance of any symptoms, through screening by gynecological examination, Pap smear or HPV test.

    It should also be mentioned in the presence of non-specific symptoms: spontaneous vaginal bleeding or bleeding caused by sexual intercourse, vaginal discharge, pelvic pain, pain during sexual intercourse, discomfort during the evacuation of urine or stool, etc. These symptoms must be consulted without delay.

    The clinical examination makes it possible to observe the cervix, to take samples (biopsies) and to begin the assessment.

    The general examination looks for abnormalities in the lumbar fossae and lymph node areas that may raise suspicion of a loco-regional or distant extension of the cancer.

    The gynecological examination includes observation of the cervix with a speculum. This provides information on the appearance, the size of the cervix and the tumor, the extension to the vagina. Biopsies can then be taken to confirm the diagnosis and provide information on the exact type of tumour.
    A vaginal examination and rectal examination are also performed, which provide information on the local extension of the disease.

    The assessment will then depend on the stage of the disease. A distinction is made schematically between the early stages and the advanced stages.

    The early stages correspond to tumors measuring less than 4cm in greatest diameter and having no extension outside the cervix (except on a minimal part of the vagina).
      - A conization can be proposed to obtain important information for the choice of treatment (diagnosis, histological type, grade, presence of lymphovascular emboli, precise size).
      - In young women, treatment that preserves the uterine body can be considered.
      - A pelvic and abdominal MRI completes the clinical assessment. It provides information on the size of the cervix and the tumor, its local extension (parameters in particular), the appearance of the pelvic and aortic-cellar lymph nodes, the kidneys, the ureters, etc.
    The FIGO stage is determined based on clinical and radiological data. It largely determines the treatment.

    Advanced stages correspond to tumors measuring more than 4cm in diameter or having an extension outside the cervix (other than limited vaginal).
    The assessment includes a pelvic and abdominal MRI as well as a PET scan. This examination is the combination of a scanner with an 18FDG scintigraphy. It makes it possible to specify the extension, in particular towards the lymph nodes.
    The assay of the SCC (squamous cell carcinoma) marker is performed in cases of squamous cell cancer.

    In the event of a clinical or radiological point of call, the assessment is completed by an endoscopic examination of the bladder (cystoscopy) or the rectum (proctoscopy).
    Other sites that may be infected with HPV (vulva, vagina, anus, throat) are also checked.