Routine pretreatment evaluation in cervical carcinoma

A review of 573 previously untreated patients with invasive cervical carcinoma was undertaken to determine the significance of the routine pretreatment performance of chest x-ray, intravenous pyelography (IVP), cystoscopy and sigmoidoscopy. Chest x-ray was performed in 570 patients (99.5%), IVP in 514 (89.7%), cystoscopy, 502 (87.6%) and sigmoidoscopy, 496 (86.6%). The overall yield of tumor-related abnormalities demonstrated in chest x-ray, IVP, cystoscopy and sigmoidoscopy was 1.8%, 9.1%. 6.4% and 1.2% respectively. The chest x-ray findings changed the initial clinical stage in 1.3% of cases, IVP in 4.2%, cystoscopy in 4.0% and sigmoidoscopy in 0.6%. There were 5 instances of bladder involvement and 5 of bullous edema of the bladder found in patients originally classified as having stage I or stage II disease. Thus, to omit cystoscopy may not be so safe in patients with stage I and stage II diseases. We suggest that chest x-ray, IVP and cystoscopy should be performed as part of staging in all patients with cervical carcinoma, however, sigmoidoscopy can be reserved for those initially diagnosed to have advanced disease or symptomatic patients.