title: Para-aortic nodal metastases in cervical cancer: a blind spot in the International Federation of Gynecology and Obstetrics staging system: current diagnosis and management.
abstract: In cervical cancer, para-aortic nodal (PALN) metastases at presentation is a strong indicator of poor prognosis. Despite this, International Federation of Gynecology and Obstetrics staging system does not require evaluation of lymph node involvement and does not incorporate clinically detected PALN into the staging system. In the USA, despite screening, a significant number of women still present at an advanced stage often with nodal metastases. While the presence of PALN metastases often indicates occult systemic disease, it is possible with modern therapies to provide long-term control of disease in a percentage of patients. We review the epidemiology, diagnosis and treatment of PALN metastases in cervical cancer outlining advances in modern imaging and combined modality therapies (surgery, chemotherapy and radiation therapy).
authors.affiliation: Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX 75390 9183, USA.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Hwang
authors.forename: April
authors.initials: A
authors.lastname: Bailey
authors.forename: Jayanthi
authors.initials: J
authors.lastname: Lea
authors.forename: Kevin
authors.initials: K
authors.lastname: Albuquerque
mesh_terms: D001011:Aorta; D003131:Combined Modality Therapy; D019468:Disease Management; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D009367:Neoplasm Staging; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000628:therapy
keywords: extended field radiation; locally advanced cervical cancer; para-aortic nodal metastases