TY - CHAP M1 - Book, Section TI - Gynecolological Malignancies A1 - Rowe, Julie H. A1 - Gonzalez, Anneliese O. A1 - Jafri, Syed H. A1 - Cen, Putao A1 - Kanaan, Zeyad A1 - Amato, Robert J. A1 - Rios, Adan A1 - El-Osta, Hazem A1 - Mohlere, Virginia PY - 2019 T2 - Hematology-Oncology Clinical Questions AB - Table Graphic Jump Location|Download (.pdf)|PrintKey conceptCervical cancer is one of the leading causes of cancer-related death among women in developing countries. It is strongly linked with human papillomavirus (HPV) infection (types 16 and 18). PAP smear is effective for early detection and reduces mortality. In the developed world, women with lower socioeconomic status and those with multiple sexual partners are more likely to develop cervical cancer.1Clinical scenarioA 44-year-old single mother with multiple sexual partners presents with post-coital bleeding. She also reports lower pelvic pain. Local examination reveals a large fungating mass in cervix. Biopsy confirms squamous cell cancer.Action itemsPelvic examination should be performed for biopsy and clinical stagingStaging studies such as CT and MRI can be performedPatients with stage IA1 to IIA1 disease can be treated with surgerySurgery can be fertility sparing, such as trachelectomy, or radical hysterectomy with bilateral pelvic lymph node dissectionDiscussionPatients are diagnosed at screening, or they may present with symptoms such as post-coital bleeding, vaginal discharge, or pelvic pain. Gynecological examination is needed for diagnosis and clinical staging (International Federation of Gynecology and Obstetrics). Most patients have squamous cell cancer; other types are adenocarcinoma and neuroendocrine histology.Patients with stage IB2 to IVA, non-metastatic disease are treated with concurrent chemoradiation.2 Concurrent chemoradiation reduces risk of death by 30%–50%. Radiation is given by external beam radiation therapy concurrent with weekly cisplatin chemotherapy. Another chemotherapy option includes cisplatin/5-fluorouracil. After concurrent chemoradiation, brachytherapy is considered the standard of care.Patients with metastatic cervical cancer are treated with doublet chemotherapy (cisplatin/paclitaxel or topotecan/paclitaxel) and bevacizumab.PearlsHPV vaccines such as Gardasil are very effective against HPV type 16 and 18 infection. They are indicated for female and male patients ages 9–26 years.ReferencesNational Comprehensive Cancer Network (NCCN) guidelines for cervical cancer. Version 1.2017. Available at: www.nccn.org.Rose PG, Bundy BN, Watkins EB, et al. Concurrent cisplatin-based radiotherapy and chemotherapy for locally advanced cervical cancer. N Engl J Med 1999;340:1144-53. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/29 UR - hemonc.mhmedical.com/content.aspx?aid=1162981353 ER -