Chapter 9 – Gynecologic Cancers

Chronic papillomavirus infection is the cardinal cause of squamous cell carcinoma of the cervix. In addition to clinical information, benign findings and pitfalls in fludeoxyglucose (FDG) PET/CT reading, and teaching cases, this chapter reviews evidence-based recommendations regarding PET/CT examination in gynecologic cancers and compares them with statements in major clinical guidelines. FDG PET/CT is recommended for staging or restaging of patients considered for exenterative surgery or radical chemoradiotherapy, response assessment of locally advanced cancer after chemoradiotherapy, and equivocal conventional imaging in suspected recurrent cervical cancers. Endometrial cancer is the fourth most common cancer and the sixth leading cause of cancer-related death. According to evidence-based data, FDG PET/CT is indicated for staging or restaging of these patients and evaluation of suspected recurrence of endometrial carcinoma when other imaging is equivocal. It has an excellent diagnostic performance for preoperative detection of lymph node metastases and malignancy recurrence. Ovarian cancer is the fifth leading cause of cancer-related death. FDG PET/CT is more accurate than CT and MRI for the detection of supradiaphragmatic metastases and assessment of recurrent ovarian cancer, particularly when the CA-125 relapsed but conventional imaging is equivocal or negative.