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

Neuroendocrine Carcinoma of the Cervix (NECC)


  • 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


  • 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

Cervical Cancer in Association with Pregnancy

  • 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


  • 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
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