Clinical Investigations

Most preinvasive dysplastic lesions are picked up because of an abnormal cervical smear. When a significant cytological abnormality is identified patients are referred to a gynaecologist for

Figure 24.1. Cervix - regional lymph nodes. 1. Paracervical nodes. 2. Parametrial nodes. 3. Hypogastric (internal iliac) including obdurator nodes. 4. External iliac nodes. 5. Common iliac nodes. 6. Presacral nodes. 7. Lateral sacral nodes. Reproduced from Hermanek P, Hutter RVP, Sobin LH, Wagner G, Wittekind Ch (eds.). TNM Atlas: illustrated guide to the TNM/pTNM classification of malignant tumours, 4th edition. Springer-Verlag: Berlin and Heidelberg, 1997.

Figure 24.1. Cervix - regional lymph nodes. 1. Paracervical nodes. 2. Parametrial nodes. 3. Hypogastric (internal iliac) including obdurator nodes. 4. External iliac nodes. 5. Common iliac nodes. 6. Presacral nodes. 7. Lateral sacral nodes. Reproduced from Hermanek P, Hutter RVP, Sobin LH, Wagner G, Wittekind Ch (eds.). TNM Atlas: illustrated guide to the TNM/pTNM classification of malignant tumours, 4th edition. Springer-Verlag: Berlin and Heidelberg, 1997.

colposcopy. This involves looking at the cervix under a special microscope (colposcope) and often taking a biopsy or performing local excision of an abnormal area of cervix (loop or cone biopsy). These areas are identified by their lack of uptake of iodine stain (acetowhite epithelium - AWE) and abnormal surface appearances (e.g., vascular punctation or a mosaic pattern). HPV testing may also be undertaken and involves molecular testing of material taken at a cervical smear. In patients with cervical discharge material may be sent for microbiological investigations. In cases of cervical tumour, radiological investigation, usually in the form of MRI, is carried out for staging purposes.

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