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Lymph Node Spread in Cancer of the Cervix

Cancer of the Cervix can spread to the lymph nodes in the pelvis or para-aortic region(nodes in green on diagram on the left. see node labelsradiation field,   more detailed and node spread, and risk of spread.)   Spread to the lymph nodes higher in the abdomen (around the aorta, so called para-aortic) is more serious than pelvic node spread. These nodes can sometimes be seen on CT scan but often require a surgical biopsy to confirm spread.The risk of spread to the lymph nodes is related to the size and stage of the cancer as noted in the tables below. The survival rates are much lower if the cancer has spread to pelvic nodes (50 - 80%) or para-aortic nodes (29 - 50% go here) but as noted in the recent studies combing chemotherapy with radiation, the survival rates with postoperative radiation combined with Platinol can be in the 67 - 87% range, so these patients should all receive chemo-radiation after surgery. (Go  here and here.)


Risk of Pelvic Lymph Node Spread (from Leibel & Phillips)
Depth < 3mm < 1% Stage I 11 - 18%
" 3 - 5 mm 1 - 8% Stage II 32 - 45%
"  6 - 10 mm 15% Stage III 46 - 66%
  "  11 - 15 mm 22%    
"16-20 mm 39% Grade I 9.7%
lymphvascular (-) 8.2% Grade II 13.9%
lymphvascular (+) 25.4% Grade III 21.8%
 
The survival rate falls if the cancer has spread to the pelvic nodes, for stage IB node negative (89.5%/5y) to 59% if node positive, the survival by number of involved pelvic nodes for stage Ib-IIb is as noted below:

Survival by Number of Pelvic Nodes Involved
Nodes Involved 5 Year Survival Rate (Ib-IIb)
0 89%
1 81%
2 - 3 63%
4 - 18 41%
 
The survival rate falls further if  the cancer has spread to the para-aortic nodes ( in one series the survival was 80% for pelvic node spread but only 48% with para-aortic spread. The survival range in the literature is from 29 - 50%). The risk of spread to these nodes is noted in the table below:

Risk of Para-Aortic Node Spread
Stage Risk of Para-Aortic Node Spread
Ib 5%
IIa 10%
IIb 19%
IIIa 20%
IIIb 29%
IV 30%

Frequency of lymph node metastases in cervical carcinoma. Incidence of node group involvement in 26 nontreated cases of cervical carcinoma.