The ultrasound appearance of cervical carcinoma is commonly that of a hypoechoic or isoechoic mass, which may occlude the endocervical canal and hydro or pyometra may result. In more than half the cases the mass is isoechoic, in which case cervical enlargement may be the only finding. Transrectal ultrasound may show an ill-defined mass in some of these cases, but lack of contrast resolution may still pose a problem. In these cases MRI is superior. Parametrial invasion may be seen as replacement of the normal echogenic fat by hypoechoic tumor which may extend up to the pelvic side walls. Ultrasound demonstrates this finding well, but MRI is the superior modality. Studies have reported the use of a intracervical probe to improve the visibility and assess the degree of invasiveness of the mass. Ureteral obstruction with hydronephrotic changes in the kidneys and nodal involvement can be demonstrated by transabdominal ultrasound; however this is dependent on the body habitus. Endoluminal ultrasound can identify bladder and rectal wall invasion in unsuspected cases.

Color Doppler studies have a controversial role in cervical cancer. A few studies have described the color Doppler appearance of neovascularity in the mass but the Doppler findings are not definitive. It may be possible to monitor the response to chemotherapy via transvaginal color Doppler. Combined clinical and radiological staging can identify the patients needing post surgical radiotherapy and/or chemotherapy and help in the treatment planning versus clinical exam alone.

Local recurrences following treatment are well assessed radiologically by ultrasound. In cases of doubt, MRI may be performed.