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KEY CONCEPTS

  • Cancer of the cervix is the third most common gynecologic malignancy in the United States. The American Cancer Society estimated that there would be a total of 13,800 new cases of invasive cervical cancer and 4290 deaths in 2020.

  • The nonavalent vaccine (Gardasil-9), which targets HPV-6, -11, -16, -18, -31, -33, -45, -52, and -58, is recommended to both boys and girls between the ages of 11 and 12 years old. A two-dose schedule with a 6- 12-month interval between doses is recommended if given before age 15 years. For people older than 15 years old or immunocompromised, three doses are required (0, 1–2, and 6 months).

  • The 2018 revised International Federation of Gynecology and Obstetrics (FIGO) staging system main changes from the previous 2009 are the allowance of images and pathology, when available to allocate the stage. For stage IA only, depth of invasion (≤3 mm and >3 mm and ≤5 mm) is now considered to allocate a tumor as IA1 or IA2, respectively, because horizontal extent is no longer contemplated. Stage IB tumors are now divided according to their greatest dimension into IB1 (≤2 cm), IB2 (>2 cm and ≤4 cm), and IB3 (>4 cm). Nodal compromise is now considered part of the staging system. Positive pelvic nodes are now allocating as IIIC1 and positive paraaortic nodes are considered stage IIIC2.

  • Radical hysterectomy with pelvic lymphadenectomy is the standard treatment for early-stage cervical cancer (FIGO 2018 IA2-IB2). After the results of a prospective randomized trial showing that minimally invasive surgery was associated with higher rates of locoregional recurrences (hazard ratio [HR], 4.26; 95% confidence interval [CI], 1.44-12.6; P = .009) and higher risk of death (HR: 6.00; 95% CI,1.77–20.3; P = .004], minimally invasive surgery is no longer recommended.

  • First-line therapy recommended for recurrent of metastatic disease is cisplatin, paclitaxel, and bevacizumab. The Gynecologic Oncology Group 240 randomized trial showed that the addition of bevacizumab resulted in a significant improvement in overall survival compared with chemotherapy alone (median, 16.8 vs 13.3 months, respectively; HR, 0.77; 98% CI, 0.62–0.95).

  • Pembrolizumab is the preferred regimen for second-line therapy in patients with recurrent or metastatic disease who are tumor programmed death-ligand 1 with an overall response rate as showed by the KEYNOTE-028 trial of 17% and duration of response was 5.4 months.

INTRODUCTION

Cervical cancer is the third most common gynecologic malignancy in the United States. In 2020, the American Cancer Society estimated that there would be a total of 13,800 new cases of invasive cervical cancer and 4290 related deaths.1 Persistent human papillomavirus (HPV) infection is the most important factor in the development of cervical cancer.2 The incidence of this disease has decreased steadily over the past several decades because of screening tests and vaccination. Squamous cell carcinoma (SCC) and adenocarcinoma are the most common histologic subtypes.

The median age of diagnosis of cervical cancer is 50 years of age, and it ...

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