cervical%20cancer%20-%20treatment
CERVICAL CANCER - TREATMENT
Treatment Guideline Chart
Patients with abnormal Pap smear are referred for colposcopy to screen for presence of cervical cancer.
Colposcopic exam should include inspection of the transformation zone, definition of the extent of the lesion and biopsy of the most abnormal area for tissue diagnosis.
The earliest stages of cervical carcinoma are generally asymptomatic.
Watery vaginal discharge, postcoital or postmenopausal bleeding, intermittent spotting, or abdominal pain may be present and is usually unrecognized by the patient.

Cervical%20cancer%20-%20treatment Management

Incidental Finding of Invasive Cancer After Extrafascial Hysterectomy

  • Patients without lymphovascular invasion should undergo surveillance
  • Patients with lymphovascular invasion should undergo imaging
    • Patients with negative imaging and negative margins may undergo pelvic EBRT with brachytherapy with or without concurrent platinum-containing chemotherapy or complete parametrectomy or upper vaginectomy with pelvic lymphadenectomy with or without para-aortic lymph node sampling
      • Patients with negative nodes and without residual disease should undergo observation
      • Patients with positive nodes and/or positive surgical margin and/or positive parametrium should undergo pelvic EBRT or para-aortic lymph node EBRT if positive for para-aortic lymph node, with concurrent platinum-containing chemotherapy with or without individualized brachytherapy

Monitoring

  • Follow-up visit every 3-6 months x 2 years, then every 6-12 months x 3-5 years, then annually according to patient's risk of disease recurrence
  • Cervical/vaginal cytologic exam annually as indicated
  • Consider CBC, BUN, creatinine as indicated according to patient's symptoms or examination findings suspicious for disease recurrence
  • Stage-dependent imaging should be based on patient’s symptoms and concern for metastatic or recurrent disease
    • Patients with stage I may undergo neck/chest/abdomen/pelvis/groin PET/CT if suspicious of metastasis
      • Pelvic MRI with contrast at 6 months post surgery then annually for 2-3 years should be considered for patients who underwent fertility-sparing procedures
      • Patients with non-fertility sparing procedures with stage IB3 or with postoperative adjuvant radiation or chemoradiation for high-risk factors (positive nodes, margins or parametria) may undergo neck/chest/abdomen/pelvis/groin PET/CT at 3-6 months posttreatment completion
    • For patients with stage II-IV, the following may be performed:
      • At 3-6 months posttreatment completion, whole body PET/CT (preferred), CT with contrast of the chest, abdomen or pelvis, or MRI with contrast of the pelvis (optional)
    • Patient with stage IVB or recurrence should undergo imaging with CT, MRI, or PET/CT) when appropriate to evaluate response to treatment or determine further treatment
    • Patients with suspected recurrence or metastasis should undergo neck/chest/abdomen/pelvis/groin
      • Pelvic MRI may be performed in patients with suspected recurrence or metastasis
  • 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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