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CERVICAL CANCER - TREATMENT
Patients w/ abnormal Pap smear are referred for colonoscopy to screen for presence of cervical cancer.
Colposcopic exam should include inspection of the transformation zone, definition of the extent of the lesion & biopsy of the most abnormal area for tissue diagnosis.
The earliest stages of cervical carcinoma are generally asymptomatic.
Watery vaginal discharge & postcoital bleeding or intermittent spotting may be present & are usually unrecognized by the patient.

Monitoring

Cervical Cancer Stage IA1

  • Follow-up visit every 3-6 months x 2 years, then every 6-12 months x 3-5 years, then annually
  • Cervical/vaginal cytologic exam annually as indicated
  • Consider complete blood count (CBC), blood urea nitrogen (BUN), creatinine every 6 months or as indicated
  • Imaging should be based on patient’s symptoms and concern for metastatic or recurrent disease
  • Educate patient on potential recurrence symptoms, effects of treatment, periodic self-examinations, and sexual health (eg use of vaginal dilator, vaginal moisturizers/lubricants)
  • Counsel patient on exercise, obesity, nutrition, lifestyle and smoking cessation

Cervical Cancer Stage IA2, IB1, IIA1

  • Follow-up visit every 3-6 months x 2 years, then every 6-12 months x 3-5 years, then annually
  • Cervical/vaginal cytologic exam annually as indicated
  • Consider CBC, BUN, creatinine every 6 months or as indicated
  • Imaging should be based on patient’s symptoms and concern for metastatic or recurrent disease
  • Educate patient on potential recurrence symptoms, effects of treatment, periodic self-examinations, and sexual health (eg use of vaginal dilator, vaginal moisturizers/lubricants)
  • Counsel patient on exercise, obesity, nutrition, lifestyle and smoking cessation

Cervical Cancer Stage IB2, IIA2, IIB, IIIA, IIIB, IVA

  • Follow-up visit every 3-6 months x 2 years, then every 6-12 months x 3-5 years, then annually
  • Cervical/vaginal cytologic exam annually as indicated
  • Consider CBC, BUN, creatinine every 6 months or as indicated
  • Imaging should be based on patient’s symptoms and concern for metastatic or recurrent disease  
    • At 3-6 months posttreatment completion, the following may be performed:
      • Stage IB2: Whole body PET/CT
      • Stage II-IV: Whole body PET/CT (preferred), CT with contrast of the chest, abdomen or pelvis, or MRI with contrast of the pelvis (optional)
  • Educate patient on potential recurrence symptoms, effects of treatment, periodic self-examinations, and sexual health (eg use of vaginal dilator, vaginal moisturizers/lubricants) 
  • Counsel patient on exercise, obesity, nutrition, lifestyle and smoking cessation

Metastatic Cervical Cancer

  • Follow-up visit every 3-6 months x 2 years, then every 6-12 months x 3-5 years, then annually
  • Cervical/vaginal cytologic exam annually as indicated
  • Consider CBC, BUN, creatinine every 6 months or as indicated
  • Imaging should be based on patient’s symptoms and concern for metastatic or recurrent disease
  • Educate patient on potential recurrence symptoms, effects of treatment, periodic self-examinations, and sexual health (eg use of vaginal dilator, vaginal moisturizers/lubricants)
  • Counsel patient on exercise, obesity, nutrition, lifestyle and smoking cessation
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