Cervical Cancer – Hysterosalpingography
Cervical cancer is a malignant tumor arising from the epithelial lining of the cervix, most commonly squamous cell carcinoma. It is a leading cause of gynecologic cancer morbidity in developing countries. Hysterosalpingography (HSG) is not a diagnostic or staging modality for cervical cancer; however, abnormal findings may be encountered incidentally when the study is performed for infertility or other indications. On HSG, cervical cancer may be suggested by irregular cervical canal narrowing, rigidity, shouldering, or complete obstruction to contrast passage (Fig. 1).
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| Fig-1 |
Findings: The cervical canal demonstrates irregular narrowing with mucosal destruction and poor distensibility. Contrast passage may be delayed or completely obstructed. Uterine cavity opacification is often incomplete.
Conclusion: Hysterosalpingographic appearance is suspicious for cervical pathology. Malignancy must be excluded with clinical examination and biopsy.
Patient Symptoms
Patients commonly present with postcoital bleeding, irregular vaginal bleeding, foul-smelling vaginal discharge, pelvic pain, or dyspareunia. Advanced disease may cause urinary or rectal symptoms.
Procedure (Hysterosalpingography)
HSG is contraindicated when cervical cancer is clinically suspected. If performed inadvertently, cannulation is often difficult due to cervical rigidity or friability, and the study should be terminated at the first sign of abnormal resistance or bleeding.
Contrast Medium & Administration
A water-soluble iodinated contrast agent such as Iohexol or Iopamidol (300–350 mg iodine/mL) may be used incidentally. The patient is positioned in the lithotomy position. Only minimal contrast (2–4 mL) should be injected gently if abnormal cervical resistance is encountered.
Instruments Used
- Sterile vaginal speculum (Cusco’s or Sims’)
- Fine HSG balloon catheter
- Leech–Wilkinson cannula (with caution)
- 10–20 mL sterile Luer-lock syringe
- Sterile connecting tubing
- Antiseptic solution
- Fluoroscopy unit
Safety Considerations
HSG should be avoided in suspected cervical cancer due to the risk of bleeding, infection, and tumor dissemination. Any abnormal cervical appearance during cannulation mandates immediate termination of the procedure and gynecologic referral.
Related Conditions
Differential diagnoses include cervical stenosis, chronic cervicitis, post-radiation fibrosis, and benign cervical polyps. Diagnosis and staging rely on Pap smear, colposcopy, biopsy, MRI, and clinical examination.
Declaration
This case is presented for academic and educational purposes only. Patient confidentiality has been preserved and no identifiable information is disclosed.
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