title: Assessing disease extent in women with bulky or clinically evident metastatic cervical cancer: yield of pretreatment studies.
abstract: OBJECTIVE
  The objective of this study was to determine the impact of pretreatment tests on staging and management for women with bulky or clinically evident metastatic cervical cancer.
  
  
  METHODS
  Demographics and findings of clinic pelvic examination (PE), examination under anesthesia (EUA), chest x ray (CXR), abdominopelvic computed tomography (CT), and intravenous urography (IVU) were reviewed for women with primary, untreated cervical cancers either > or =4 cm or with extracervical disease apparent on PE or CXR evaluated between July 1, 1994, and March 31, 1999. Stage was assigned according to standards of the International Federation of Gynecology and Obstetrics.
  
  
  RESULTS
  In 133 women studied, tumor diameter averaged 4. 9 cm on PE and 5.7 cm at EUA (P = 0.0005). Of 92 women undergoing both PE and EUA, 30 (33%) had size discrepancies of more than 1 cm. Compared with EUA, PE had sensitivity, specificity, and positive and negative predictive values, respectively, of 65, 89, 79, and 81% for vaginal disease, 74, 91, 95, and 63% for parametrial disease, and 57, 90, 60, and 89% for sidewall fixation. CXR was abnormal in 5 (4%). IVU showed ureteral dilation in 20 (22%) of 90 women, while CT showed dilation in 34 (28%) of 123 women. CT also showed pelvic lymphadenopathy in 22 (18%) women and paraaortic lymphadenopathy in 12 (10%). Bladder biopsies showed malignancy in 8 (8%), including one transitional cell carcinoma of the bladder. Proctoscopy failed to reveal metastatic cervical cancer.
  
  
  CONCLUSIONS
  CXR and EUA with cystoscopy are important to the accurate staging and treatment of bulky or clinically metastatic cervical cancers, while proctoscopy is rarely useful. CT predicts ureteral obstruction well, and its greater information yield may justify its higher cost compared with IVU.
authors.affiliation: Division of Gynecologic Oncology, Cook County Hospital and Rush Medical College, Chicago, Illinois 60612, USA. lsmassad@ameritech.net
authors.forename: L S
authors.initials: LS
authors.lastname: Massad
authors.forename: C
authors.initials: C
authors.lastname: Calvello
authors.forename: S H
authors.initials: SH
authors.lastname: Gilkey
authors.forename: N R
authors.initials: NR
authors.lastname: Abu-Rustum
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000758:Anesthesia; D005260:Female; D006801:Humans; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging / Q000379:methods*; D010808:Physical Examination; D014057:Tomography, X-Ray Computed; D014567:Urography; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000601:surgery