Cervical cancer (CC) is the fourth most frequently diagnosed cancer and the fourth leading cause of cancer death in women worldwide, and it is ranked 14th among all cancers, affecting mainly young and middle-aged women [1]. It is strongly related to the country's economic status and social structure, representing the second most common cancer in low- and middle-income countries, and the third most common cause of cancer deaths [2].
There are ten major histopathologic subtypes of CC, but the most common are keratinized squamous cell carcinoma, non-keratinized squamous cell carcinoma, adenocarcinoma, and adenosquamous carcinoma [3]. Seventy-five percent of cases are squamous cell carcinoma, followed by adenocarcinoma (10-25%); the others comprise less than 5% of the cases [4].
The main cause of CC is the infection with HPV, and almost 99% of all cases are caused by persistent infection of the lower genital tract by the virus, which is sexually transmitted. There are more than 130 known HPV, with 20 HPV types identified as cancer-related, but HPV-16 and HPV-18 cause 70-75% of cervical cancers worldwide [5]. Precancerous lesions develop in about 10% of women infected with HPV, progressing later to cervical cancer [6].
Women with CC are usually asymptomatic during the initial stages, and symptoms like menstrual irregularities, abnormal bleeding, persistent vaginal discharges, or irritations are non-specific findings [7]. Screening by Pap or HPV testing is essential in the workup and diagnosis of patients with CC or precancerous lesions [8].
Accurate staging of cancer in general and CC in particular is crucial to plan the most appropriate treatment. The last edition of FIGO classification (2018), included beyond the traditional clinical findings, imaging, and pathologic findings, implementing the lymph node involvement as a separate stage (stage IIIC) [9].
The role of imaging in staging before treatment is now crucial, and MRI is the gold standard for staging and follow-up, due to its excellent soft tissue contrast, permitting a better evaluation of cervical stroma, parametria, lymph node, and neighboring organs invasion [10]. It is important to know which sequences in MRI should be used for an accurate diagnosis, including diffusion-weighted imaging (DWI) and dynamic contrast enhancement imaging (DCE) [11].
T2WI is the most important sequence to evaluate parametrial invasion, and the maintenance of a stromal border thickness > 3 mm excludes parametrial invasion, but the presence of cervical edema or inflammation could be wrongly interpreted as parametrial invasion [12].
MRI has great accuracy in evaluating the extent of disease in the cervix and the tumor extension through the pelvis, important to the management of the disease and choosing the better treatment option, especially taking into account the woman's age, allowing to select patients to fertility-sparing surgery (radical trachelectomy), given its accuracy in determining the size of the tumor, length of the cervix, and distance from the tumor to the internal cervical os [13]. The standard of treatment for early cervical cancer is radical hysterectomy with pelvic lymphadenopathy, and radical trachelectomy in selected patients [14]. Chemoradiation followed by brachytherapy is the standard treatment for patients with locally advanced cervical carcinoma [13,14].