Invasive Cervical Cancer
Key Points
Key Points
- If follow-up is available, the Expert Panel recommends cone biopsy for women with stage IA2 disease in basic settings and cone biopsy plus pelvic lymphadenectomy in limited settings. In enhanced and maximal settings, radical trachelectomy is recommended for patients with stage IB1 cervical cancer with tumor size ≤2 cm who desire fertility-sparing surgery.
- In basic settings where patients cannot be treated with radiation therapy, extrafascial hysterectomy either alone or after chemotherapy may be an option for women with stage IA1 to IVA cervical cancer.
- In basic settings, for women with larger tumors or advanced-stage cervical cancer, neoadjuvant chemotherapy is recommended, whenever chemotherapy is available, for the purpose of shrinking the tumor before performing hysterectomy.
- Concurrent radiotherapy and chemotherapy is standard in enhanced and maximal settings for women with stage IB to IVA disease.
- The panel stresses the addition of low-dose chemotherapy during radiotherapy but not at the cost of delaying radiation therapy if chemotherapy is not available.
- In limited-resource settings where there is no brachytherapy, the ASCO Expert Panel recommends extrafascial hysterectomy or its modification for women who have residual tumor 2–3 months after concurrent chemoradiotherapy and additional boost.
- For patients with stage IV or recurrent cervical cancer, single-agent chemotherapy (carboplatin or cisplatin) is recommended in basic settings.
- If the resources are available and the patient cannot receive treatment with curative intent, palliative radiotherapy should be used to relieve symptoms of pain and bleeding.
- Where resources are constrained, single- or short-course radiotherapy schemes can be used with retreatments if feasible for persistent or recurrent symptoms.
- Palliative care and pain management are part of the treatment of cancers, including cervical cancer, to avoid unnecessary suffering during the final stages of disease. Pain control is a vital component of palliative care, a basic human right often neglected in cancer control programs.
Facility Specifications
...ility Specificat...
...tion from 2021 Focused Guideline U...
...offer upfront pembrolizumab and chemothe...
...Plus the other 2016 op...
...able 1. Treatment CapacityHaving trouble viewin...
Diagnosis
...agnosis
...ation (Table 2)
Basic
...story and physical examination, CBC, cervical b...
...tional in ≤ stage IB1 disease): chest x-ray (I,...
...cessation and counseling; may offer HI...
...mited...
...ysical examination, CBC, cervical biopsy, pathol...
...ging (optional in ≤ stage IB1): chest x-ray,...
...ng cessation and counseling; may offer HIV...
Enhanced
...story and physical examination, CBC, cer...
...ptional in ≤ stage IB1): chest x-ray, CT, or M...
...king cessation and counseling; may o...
Maximal
...d physical examination, CBC, cervical biopsy,...
...maging (optional in ≤ stage IB1): ch...
...sation and counseling; may offer HIV testing Optio...
...indicates addition of a recommended action over...
Treatment
Treatme...
...tions for Stage IA, IB, and IIA Disea...
...negative, FS (see Discussion in full text Guideli...
...ic1A1 (negative margins): cone biopsya (w...
...ited1A1 (negative margins): cone biopsy. Repea...
...1 (negative margins): cone biopsy. R...
...imal1A1 (negative margins): cone biopsy....
...SI positive, FS...
...biopsy in selected cases, if follow-up po...
...e biopsy (I, CB, W)7442...
Enhance...
...psy plus PLND (see Discussion in full text Guidel...
OR radical trachelectomy plus PLND (I, E...
...axima...
...y plus PLND (H, EB/CB, S)7442...
...electomy plus PLND (may offer ±SLN) (I, E...
...1, non-FS (no LVSI)
...opsy (if follow-up possible) OR extrafascia...
...one biopsy (if follow-up possible); observe (afte...
...one biopsyc OR extrafascial hyster...
...malCone biopsyc OR extrafascial hysterecto...
...on-FS (with LVSI)...
...bove (L, CB, W)7442
LimitedStage IA1 (with LVSI) and stage I...
...nhancedStage IA1 (with LVSI) and stage IA2...
...lStage IA1 (with LVSI) and stage IA2: modified rad...
...2, FS...
...psy (if follow-up possible) (L, CB, W)7442...
...opsy (if follow-up possible) (L, CB, W)7442...
...hanced...
...opsy plus PLND ± para-aortic LN samplingc...
...trachelectomy plus PLND (I, EB, M)7442
Maximal
...biopsy plus PLND ± para-aortic LN sam...
...ectomy plus PLND (I, EB, M)7442...
...A2, non-FS...
...asic
...opsy (if follow-up possible) or extraf...
...ascial hysterectomy (L, EB, W)74...
...mited...
...biopsy plus PLND ± para-aortic LN sam...
...ified radical hysterectomy plus PLN...
Enhance...
...biopsy plus PLND ± para-aortic LN samplingc (L...
...ified radical hysterectomy plus PLND ± para-a...
...RT and brachytherapy (I, EB, M)7442...
...ximal...
...above Modified radical hysterectomy plu...
...c RT and brachytherapy (I, EB, M)7442...
...1, FS
...recommendation (, , )7442...
...recommendation (, , )7442...
...ncedRadical trachelectomy plus PLND...
...alRadical trachelectomy plus pelvic...
..., non-FS...
Basi...
...ysterectomy (Insufficient Quality of...
NACT if available, then extrafascial hyste...
...mited...
...cal hysterectomy plus PLND or radical h...
...by extrafascial or radical hysterectomy (see Note...
...nhance...
...rectomy plus PLND (H, EB, S)7442
...plus brachytherapy plus concurrent...
...aximal
...terectomy plus PLND; may offer SLN (H, EB,...
...on (L, EB, W)7442...
...ic RT plus brachytherapy plus concurre...
...ote
...rever radical hysterectomy with concurre...
...and IIA2...
...asic...
...otherapy is available, use NACT fo...
Limit...
If chemotherapy is available, NACT...
...ailable, but not brachytherapy, then chemoRT...
...EBRT is available, then brachytherapy and concur...
...ical hysterectomy plus PLND ± para-aortic LN...
...hanced
...concurrent low-dose platinum-based c...
...elvic RT plus concurrent low-dose plat...
...hysterectomy plus PLND ± para-aortic LN samplin...
Maximal
...vic RT plus concurrent low-dose platinum-based c...
...plus concurrent low-dose platinum-based chemoth...
...al hysterectomy plus PLND ± para-aortic...
Note
...isk factors on pathology specimen: adjuvan...
...edWith risk factors on pathology sp...
...th risk factors on pathology specimen: adjuvan...
...risk factors on pathology specimen: adjuvant R...
...See IB1...
...d indicates addition of a recommended...
...3a. Combination of Three Risk Factors:...
...commendations for Stage IIB, III, IVA, and IVB an...
IIB and...
...asic
...followed by extrafascial hysterectom...
...rafascial hysterectomy when chemotherapy is not co...
...iative care (I, CB, S)7442...
Limited
or RTa followed extrafascial or modifi...
...trafascial or modified hysterectomy plu...
...hanced...
...us concurrent low-dose platinum-based...
Maxim...
...lus concurrent low-dose platinum-based...
IIIB to IVA
...asic...
...care (I, EB, S)7442...
...by extrafascial hysterectomy (Quali...
...mited...
...wed by extrafascial or radical hysterectomy...
...nt low-dose platinum-based chemotherapy (may offer...
...nhance...
...brachytherapy plus concurrent low-dose platinum-...
...ytherapy ± concurrent low-dose platinu...
...aximal...
...rachytherapy plus concurrent low-dose platinu...
...achytherapy ± concurrent low-dose pla...
Not...
...radical hysterectomy with concurrent chemoRT l...
IV...
...ve care and chemotherapy (if available...
...mitedPalliative care and/or chemoth...
...therapy ± individualized RT and/or p...
...alChemotherapy ± bevacizumab ± individualized...
...current...
...asic
...liative care (H, EB, S)...
...disease: chemotherapy (Quality of Evidence:...
Limited
...epending on previous RT and either â€...
...nhance...
...revious RT and central vs. noncentral disease:...
...plus central disease: pelvic exenter...
...ximal
...vious RT and central vs. noncentral disease: Cen...
...s central disease: pelvic exenteration...
Note
...asic
...his is best managed with exenteration (type of...
...mited
...RT plus noncentral disease: chemot...
...hanced
...ior RT plus noncentral disease: tumor-direc...
...lliative care alone, try options such as RT boost...
...aximal...
...ior RT plus noncentral disease: tumor-directe...
...fter any of the above, then clinical trial...
...tion from 2021 Focused Guideline Update (plus th...
Table Views
Table Views
...EvaluationHaving trouble viewing tab...
...commendations for Stage IA, IB, and IIA DiseaseHav...
...mendations for Stage IIB, III, IVA, and IVB a...