Overview of approach to cervical cancer survivors
- Linda R Duska, MD
Linda R Duska, MD
- Associate Professor
- Fellowship Director
- Gynecologic Oncology
- University of Virginia
- Section Editor
- Larissa Nekhlyudov, MD, MPH
Larissa Nekhlyudov, MD, MPH
- Section Editor — Cancer Survivorship
- Director of Cancer Research
- Department of Population Medicine
- Associate Professor
- Harvard Medical School
- Deputy Editors
- Sadhna R Vora, MD
Sadhna R Vora, MD
- Deputy Editor — Oncology
- Instructor in Medicine
- Harvard Medical School
- Sandy J Falk, MD, FACOG
Sandy J Falk, MD, FACOG
- Senior Deputy Editor — UpToDate
- Deputy Editor — Obstetrics, Gynecology and Women's Health
- Clinical Instructor of Obstetrics, Gynecology and Reproductive Biology
- Harvard Medical School
While cervical cancer is the fourth most common cancer of women in the world, the number of cases has continuously declined in regions where screening programs have been implemented. However, in resource-poor areas, where screening programs are not well established, cervical cancer continues to affect and kill hundreds of thousands of women. In 2013, approximately 528,000 new cases were diagnosed worldwide and were responsible for over 260,000 deaths, making it the fourth most common cause of cancer death in women . Seventy percent of the global burden occurs in resource-poor countries, with more than one-fifth of these diagnosed in India .
Compared with other gynecologic cancers, cervical cancer most often affects younger women, with a mean age at diagnosis of 50 years . Many of these women with early-stage disease will be cured and have significant additional life expectancy following completion of treatment. Consequently, they will face years of potential treatment-related side effects. They may also have concerns regarding fertility preservation. Finally, given their younger age, these women may have more family and work responsibilities than women with other gynecologic cancers . This topic will review the approach to cervical cancer survivors.
OVERVIEW OF PRIMARY TREATMENT
Following a diagnosis of cervical cancer, all women undergo a pretreatment staging evaluation to help determine the approach, which can then be stratified on whether the disease is early or locally advanced at presentation. The overwhelming majority of long-term cervical cancer survivors were originally treated for early-stage or locally advanced cervical cancer. In contrast, the median survival of women diagnosed with metastatic or recurrent cervical cancer is generally less than two years. Therefore, this section will review the treatment of women with early-stage or locally advanced cervical cancer.
Early-stage cervical cancer — Early-stage cervical cancer is defined as disease confined to the cervix measuring less than 4 cm in size (stage IA to IB1) (table 1). These patients may be appropriately treated with either radical surgery or concomitant chemoradiation, which is usually based on the volume of disease, patient characteristics, and surgical judgment . (See "Management of early-stage cervical cancer".)
Primary treatment — Various procedures are performed for the management of early-stage cervical cancer that range from fertility-sparing options to hysterectomy. For most of these patients, a modified radical hysterectomy will have been performed, which entails removal of the parametrial and paravaginal tissue to include a 2 cm margin of normal tissue around the tumor, and excision of the upper one-third of the vagina. In addition to the hysterectomy, most will have undergone removal of the regional retroperitoneal lymph nodes, which may lead to subsequent issues with lymphedema, among other issues. (See 'Lymphedema' below.)
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- OVERVIEW OF PRIMARY TREATMENT
- Early-stage cervical cancer
- - Primary treatment
- - Adjuvant therapy
- - Oophoropexy
- Locally advanced cervical cancer
- - Adjuvant chemotherapy
- - Adjuvant hysterectomy
- POSTTREATMENT SURVEILLANCE
- Components of follow-up
- Role of imaging
- PATTERNS OF RECURRENCE
- SPECIFIC ISSUES
- Bladder dysfunction
- Bowel dysfunction
- Sexual dysfunction
- Psychosocial issues
- COORDINATION OF CARE
- SUMMARY AND RECOMMENDATIONS