From the Guidelines
Para-aortic lymphadenopathy is typically evaluated by specialists in gynecologic oncology, particularly for patients with cervical cancer, as evidenced by the 2019 NCCN clinical practice guidelines in oncology 1. When para-aortic lymphadenopathy is suspected, the initial evaluation often involves radiologic imaging studies, such as PET/CT, to assess nodal involvement in the pelvic and para-aortic nodes 1.
- Key specialties involved in the evaluation and management of para-aortic lymphadenopathy include:
- Gynecologic oncology: for cases related to gynecological cancers, such as cervical cancer
- Radiology: for initial identification of enlarged para-aortic lymph nodes through imaging studies
- Oncology: for cases suspected to be related to cancer, including testicular cancer, ovarian cancer, lymphoma, or gastrointestinal cancers
- General surgery: for potential biopsies of these lymph nodes when necessary for definitive diagnosis The evaluation and management of para-aortic lymphadenopathy require a multidisciplinary approach, with gynecologic oncologists playing a crucial role in the management of patients with cervical cancer and para-aortic lymph node involvement, as recommended by the NCCN guidelines 1.
From the Research
Specialties that See Para-Aortic Lymphadenopathy
The specialties that see para-aortic lymphadenopathy include:
- Gynecologic oncology, as para-aortic lymphadenopathy is a common issue in cervical cancer and ovarian cancer patients 2, 3, 4, 5, 6
- Radiation oncology, as radiation therapy is often used to treat para-aortic lymphadenopathy in cervical cancer patients 2, 6
- Surgical oncology, as surgical staging and treatment of para-aortic lymphadenopathy is sometimes necessary in ovarian cancer and cervical cancer patients 3, 4, 5
Key Findings
Some key findings related to para-aortic lymphadenopathy include:
- The clinical dose response threshold for pelvic and para-aortic lymph node boost using radiographic imaging and clinical outcomes is around 54 Gy 2
- Pre-treatment surgical para-aortic lymph node assessment may not be beneficial and may actually have an adverse effect on survival in locally advanced cervical cancer patients 3
- Patients with serous ovarian carcinomas and a poorer degree of differentiation are at risk of associated lymph node metastases even in presumed early stages of the disease 4
- Pelvic and para-aortic lymphadenectomy in surgical staging of apparent early-stage epithelial ovarian cancer improves disease-free survival but does not affect overall survival 5
- The best approach to managing para-aortic lymph node disease in patients with cervical cancer is still unclear and requires further research 6