A 45-year-old G1P1 presents for her routine annual examination. The patient is a healthy smoker who has no medical problems. Her surgical history is significant for a cesarean delivery with bilateral tubal interruption. You perform a Pap smear, which returns showing high grade squamous intraepithelial lesion (HSIL). She undergoes colposcopy, which is inadequate.
Which lymph node group would be the first involved in metastatic spread of this disease beyond the cervix and uterus?
A. Common iliac nodesThe main routes of spread of cervical cancer include vaginal mucosa, myometrium, paracervical lymphatics, and direct extension into the parametrium. The prevalence of lymph node disease correlates with the stage of malignancy. Primary node groups involved in the spread of cervical cancer include the paracervical, parametrial, obturator, hypogastric, external iliac, and sacral nodes, essentially in that order. Less commonly, there is involvement in the common iliac, inguinal, and paraaortic nodes. The presence of lymph node involvement confers a worse prognosis and impacts how the patient is managed. In stage I, the pelvic nodes are positive in approximately 15% of cases and the para-aortic nodes in 6%. In stage II, pelvic nodes are positive in 28% of cases and para-aortic nodes in 16%. In stage III, pelvic nodes are positive in 47% of cases and para-aortic nodes in 28%.