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NODAL DISEASE : ANATOMY
Within the pelvis, cervical cancer spreads first to
parametrial nodes, then to obturator, internal and
external iliac nodes. In more advanced disease, common
iliac and para-aortic nodes may be involved.
Although not incorporated in the FIGO staging system,
presence of lymph node metastases has significant
prognostic and treatment consequences. The 5-year
survival for node positive patients is 39-54% compared
with 67-92% in patients without nodal involvement .
In early stage tumour, involvement of any node is
important as it excludes curative surgery changing the
treatment to either chemoradiotherapy alone, or
debulking surgery and neo-adjuvant chemoradiotherapy.
In advanced tumours, detection of para-aortic nodes is
important for planning the extent of the radiation field.