Cervical%20cancer%20-%20treatment Management

Surgery

• Stage IA, IB1, IB2, IIA1: Radical hysterectomy with bilateral salpingo-oophorectomy with bilateral lymph node dissection with para-aortic lymph node sampling
• Stage IB3, IIA2: Neoadjuvant treatment followed by radical hysterectomy with bilateral salpingo-oophorectomy with bilateral lymph node dissection with para-aortic lymph node sampling

Chemotherapy

• Preferred 1st-line regimens include Cisplatin + Etoposide or Carboplatin + Etoposide
  • Cisplatin + Etoposide: Preferred regimen
  • Carboplatin + Etoposide: For patients with Cisplatin intolerance
• Other recommended 1st-line regimens include:
  • Carboplatin/Etoposide + Atezolizumab or Durvalumab
  • Carboplatin/Paclitaxel for patients previously treated with Cisplatin
  • Cisplatin/Etoposide + Atezolizumab or Durvalumab
  • Cisplatin/Paclitaxel
  • Topotecan/Paclitaxel/Bevacizumab
• For the 2nd-line or subsequent therapy, recommended regimens are Bevacizumab, Carboplatin, Cisplatin, Cisplatin/Topotecan, Docetaxel, Irinotecan, albumin-bound Paclitaxel, Paclitaxel, Topotecan and Topotecan/Paclitaxel

• At 20-28 weeks age of gestation (AOG), individualization of treatment is in order depending on the informed consent and survival rates of the baby in the institution
• As of this writing, no studies on long-term effects of neoadjuvant chemotherapy on the baby have been encountered
• Chemotherapy can be given beyond 14 weeks up to less than 3 weeks prior to delivery
  • Chemotherapeutic agent of choice is Carboplatin
• Cesarian section may be done at 34-36 weeks following corticosteroids

Surgery

• In early age gestation and if pregnancy is desired:
  • For stage IA1, IA2, IB1, IB2, and IIA1, treatment may be delayed
  • For stage IA1, IA2, IB1, and IB2, radical hysterectomy, bilateral salpingectomy with or without bilateral oophorectomy with bilateral lymphadenectomy is the recommended treatment
  • For stage IB2 and IIA2, neoadjuvant chemotherapy is an option
    • Neoadjuvant chemotherapy may also be considered for patients with stage IA1, IA2, IB1 and IIA1 if past the 1st trimester
  • Studies showed that radical trachelectomy has been successfully performed in a few pregnant patients

• 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
• Imaging should be based on patient’s symptoms and concern for metastatic or recurrent disease
• 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
• Patient with stage IVB or recurrence should undergo imaging with CT, MRI, or FDG-PET/CT when appropriate to evaluate response to treatment or determine further treatment
• 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