Devita, Hellman, and Rosenberg's Cancer

LWBK1006-15 LWW-Govindan-Review December 7, 2011 19:5

Chapter 15•Advances in Diagnostics and Intervention 181

into adjacent fat and organs. CT and MRI have similar sensitivity and

specificity for assessing nodal involvement.

Answer 15.34. The answer is C.

Imaging in endometrial and cervical cancer is usually performed after a

diagnosis is clinically made. The main role of imaging is to determine the

depth of myometrial invasion, endocervical tumor extension and lym-

phadenopathy with endometrial cancer, and the extent of parametrial

extension and lymphadenopathy with cervical cancer. Imaging is also

performed to evaluate for distant metastases. MRI is better than CT in

delineating localized invasion of both tumors. CT is limited in depict-

ing the extent of myometrial invasion from endometrial carcinoma and

the extent of parametrial invasion from cervical cancer. MRI is approx-

imately equal to CT in delineating lymphadenopathy from gynecologic

malignancy. Although transabdominal sonography is often used to inves-

tigate the pelvis, it should not be routinely performed in endometrial can-

cer staging. Even transvaginal ultrasound is limited because of its limited

field of view and lack of soft-tissue resolution.

Answer 15.35. The answer is B.

Imaging in cervical cancer is usually performed after a positive biopsy

or PAP smear. The main role of imaging is to determine the extent of

parametrial extension and lymphadenopathy. MRI is better than CT in

delineating localized invasion. CT is limited in depicting the extent of

parametrial invasion from cervical cancer. MRI is slightly better than CT

in delineating lymphadenopathy from cervical cancer. Although transab-

dominal sonography is often used to investigate the pelvis, it should not

be routinely performed in cervical cancer staging. Even transvaginal ultra-

sound is limited because of its limited field of view and lack of soft-tissue

resolution.

Answer 15.36. The answer is D.

Imaging in adnexal masses is aimed at delineating the origin of the mass

(ovarian or uterine), whether a mass is malignant, and whether distant

metastases are present. Ultrasound is effective at identifying the location

of an adnexal tumor (bowel, ovarian, or uterine) and in distinguishing

benign from malignant disease. When ultrasound is inconclusive, CT or

MRI may be used. MRI is more accurate in separating malignant from

benign ovarian pathology. Staging accuracy for MRI equals that of CT.

Both are thought to be slightly more accurate than ultrasound, especially

in the evaluation of peritoneal disease. CT is slightly better than MRI for

the evaluation of lymphadenopathy. Both are equal in their depiction of

hepatic metastases.

Answer 15.37. The answer is D.

Digital rectal examination and serum PSA are effective means of screen-

ing for prostate cancer. Imaging plays no role in prostate cancer detec-

tion. It is useful (usually by ultrasound) for guiding biopsy. CT does not