1. Cervical Cancer: Evaluation and Management.
- Author
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Wipperman J, Neil T, and Williams T
- Subjects
- Adult, Comorbidity, Early Detection of Cancer methods, Female, Humans, Middle Aged, Neoplasm Staging, Papanicolaou Test methods, Papillomaviridae isolation & purification, Patient Selection, Pregnancy, Prognosis, Risk Assessment, Survival Analysis, United States epidemiology, Adenocarcinoma diagnosis, Adenocarcinoma mortality, Adenocarcinoma pathology, Adenocarcinoma therapy, Carcinoma, Squamous Cell diagnosis, Carcinoma, Squamous Cell mortality, Carcinoma, Squamous Cell pathology, Carcinoma, Squamous Cell therapy, Neoplasm Recurrence, Local diagnosis, Neoplasm Recurrence, Local prevention & control, Papillomavirus Infections complications, Papillomavirus Infections diagnosis, Patient Care Management methods, Pregnancy Complications, Neoplastic diagnosis, Pregnancy Complications, Neoplastic pathology, Pregnancy Complications, Neoplastic prevention & control, Uterine Cervical Neoplasms diagnosis, Uterine Cervical Neoplasms mortality, Uterine Cervical Neoplasms pathology, Uterine Cervical Neoplasms therapy
- Abstract
Human papillomavirus infection is the precursor for the development of cervical cancer and is detectable in 99.7% of squamous cell carcinoma and adenocarcinoma cases. Early detection of precancerous lesions with Papanicolaou testing remains the primary mechanism for cancer prevention. Once cervical cancer is diagnosed, treatment may involve surgery, radiation therapy, chemotherapy, or a combination. The choice of therapy depends on the stage of disease, lymph node involvement, patient comorbidities, and risk factors for recurrence. Early-stage, microinvasive disease may be treated with surgery alone if margins are negative and there is no lymph node involvement; adjuvant chemoradiation should be considered for other early-stage disease. Locally advanced disease is often treated with chemoradiation. The addition of bevacizumab, an antivascular endothelial growth factor monoclonal antibody, to combination chemotherapy improves survival among patients with recurrent, persistent, or metastatic cervical cancer. Disease stage and lymph node involvement are the most prognostic factors. Pregnancy status and desire to preserve fertility should be considered when developing a treatment strategy. After treatment, close follow-up with a gynecologist-oncologist for pelvic examinations at regular intervals is recommended to assess for recurrence.
- Published
- 2018