Invasive cervical cancer: Patterns of recurrence and posttreatment surveillance
- J Michael Straughn, Jr, MD
J Michael Straughn, Jr, MD
- Division of Gynecologic Oncology
- University of Alabama at Birmingham
- Section Editors
- Barbara Goff, MD
Barbara Goff, MD
- Section Editor — Gynecologic Oncology
- Professor of Gynecologic Oncology
- University of Washington
- Don S Dizon, MD, FACP
Don S Dizon, MD, FACP
- Section Editor – Gynecologic Oncology
- Clinical Co-Director, Gynecologic Oncology
- Founder and Director, The Oncology Sexual Health Clinic
- Massachusetts General Hospital Cancer Center
- Associate Professor of Medicine
- Harvard Medical School
Despite screening programs that have dramatically reduced the incidence of cervical cancer in the United States, cervical cancer is the fourth most common cancer in women worldwide . Squamous cell carcinoma (SCC) accounts for approximately 80 percent of cervical cancers, while adenocarcinoma accounts for 15 percent, and adenosquamous carcinoma for 3 to 5 percent; neuroendocrine or small cell carcinomas infrequently originate in the cervix. (See "Invasive cervical cancer: Epidemiology, risk factors, clinical manifestations, and diagnosis".)
Management and outcomes for women with nonmetastatic invasive cervical cancer depend upon the International Federation of Gynecology and Obstetrics (FIGO) stage of disease at diagnosis (table 1). In general, primary treatment for non-small cell cervical cancer (surgery or radiotherapy with or without chemotherapy) has a cure rate of approximately 80 to 95 percent in early-stage disease (stage I and nonbulky stage II disease) and approximately 40 to 60 percent for bulky stage II and stage III disease. A summary of survival rates by stage of disease according to the latest FIGO data is presented in the following table (table 2) .
Posttreatment surveillance after primary curative therapy for cervical cancer is uniformly recommended, although its effectiveness is not well studied. The main goal of surveillance is early detection of those recurrences that might be amenable to potentially curative salvage therapy. This is most likely with isolated central pelvic recurrences.
The timing and location of recurrent disease following potentially curative treatment for cervical cancer, the published data on the effectiveness of various surveillance strategies, and recommendations for posttreatment surveillance are reviewed here. Staging and primary management of invasive cervical cancer, as well as the approach to women treated for cervical cancer, are discussed separately. (See "Management of early-stage cervical cancer" and "Management of locally advanced cervical cancer" and "Invasive cervical cancer: Staging and evaluation of lymph nodes" and "Invasive cervical adenocarcinoma" and "Overview of approach to cervical cancer survivors".)
PATTERNS OF RECURRENCE
For women who underwent curative-intent therapy for cervical cancer, the predominant site of disease recurrence is local (ie, at the vaginal apex) or regional (ie, pelvic sidewall). The risk of persistent or recurrent pelvic disease increases with more advanced initial disease stage (table 1). As an example, one series reported pelvic failure rates of 10, 17, 23, 42, and 74 percent among 322 women undergoing radiation therapy (RT) alone for stage IB, IIA, IIB, III, and IVA disease, respectively .
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- PATTERNS OF RECURRENCE
- Effect of mode of treatment
- Symptomatology and timing
- Prognosis in recurrent disease
- SURVEILLANCE STRATEGIES
- Benefit of surveillance
- - History and physical examination
- - Cervicovaginal cytology
- - Chest radiograph
- - CT scan
- - PET/CT scan
- - Other tests
- SUMMARY AND RECOMMENDATIONS