Staging for cervix cancer: Role of radiology, surgery and clinical assessment

• Accurate staging and disease mapping is essential in the management of cervix cancer.
• We examine the role of clinical staging, pathological and radiological evaluation in providing prognostic information in order to make appropriate treatment decisions.
• We review treatment modalities for cervix cancer and provide evidence-based guidelines for patient selection for appropriate workup and management.
• International Federation of Gynecology and Obstetrics (FIGO) staging with clinical evaluation is a practical way of determining if a tumour is amendable for surgical resection.
• Further investigations are warranted in patients with locally advanced disease or large tumours (>3 cm) prior to making treatment decisions.

Staging is necessary in determining the extent of disease, its prognosis and in the formulation of optimal treatment protocols for patients with cancer. Clinical examination of patients and subsequent histopathological assessment when available has traditionally been used to determine the application of different primary and adjuvant treatment modalities. Over the years, surgery, radiotherapy and chemotherapy all have been used either singly or in combinations, and the resulting survival and patterns of failure studies have contributed much in the development of less toxic and more effective protocols. All three modalities of treatments work through separate mechanisms, and they are effective in different stages of cervix cancer. Even within the same stage, the extent of the disease, tumour volume, tissue infiltration and lymph-node metastases requires the use of differing protocols for the disease control. More recently, advances in magnetic resonance imaging (MRI) and positron emission tomography/computerised tomography (PET/CT) have made it possible to examine many of the prognostic factors non-invasively. In addition to clinical assessment, surgical and radiological staging has enabled us to triage patients far more accurately for surgery or for primary radiotherapy, such as unnecessary multimodality treatments are avoided. Only patients with poor prognosis are subjected to a combined modality treatment. Those with poorer prognosis still can be selected for clinical studies exploring new treatment.