Cervical cancer - Chronic
Definition
A malignant neoplasm arising from the uterine cervix
Initial evaluation of invasive cervical cancer
* Complete blood count
* Platelet count
* Hepatic function panel
* Measurement of renal function
Initial evaluation of invasive cervical cancer (optional for stage IB1 or less)
* Plain chest X-ray
Initial evaluation of invasive cervical cancer (stage IB2 or higher)
* Endoscopy of bladder
* Proctosigmoidoscopy with biopsy
Suspected metastasis from cervical cancer
* CT of abdomen: Pelvic/abdominal CT is most helpful for evaluating extension of disease beyond the cervix in patients with advanced cancer (stage IIB or higher) .
Suspected metastasis from cervical cancer
* MRI of abdomen: Abdominal/pelvic MRI is most helpful for evaluating extension of disease beyond the cervix in patients with advanced cancer (stage IIB or higher) .
Reassessment
Cervical neoplasia screening
* Sampling of cervix for Papanicolaou smear: Cervical cancer screening should begin at age 21 years or within 3 years of the onset of sexual activity .
Posttreatment surveillance of cervical cancer
* Complete blood count
* Blood urea nitrogen measurement
* Creatinine measurement
* Plain chest X-ray
* CT of chest
* CT of abdomen
* Positron emission tomography
Persistent or recurrent cervical cancer
* Exploratory incision
Medical History
* HPV - Human papillomavirus test positive
* Sexual behavior finding
* HIV infection
* Smoking
* Hormonal Contraceptive use
* Past medical history of Parity finding
* Estrogen/Progestin Combination use
* Diethylstilbestrol use
* Immune Suppressant use
* Legal, financial, employment and/or socioeconomic history finding
Findings
* Abdominal mass
* Cervix hard
* Edema of leg
* Flank pain
* Hematochezia
* Hematuria
* Hip pain
* Large uterine cervix
* Leg swelling
* Lesion of cervix
* Lower abdominal pain
* Lymphadenopathy
* Pain in buttock
* Respiratory auscultation finding
* Sciatica
* Abnormal vaginal bleeding
* Condyloma acuminatum - Chronic
* Vaginal discharge
Tests
Management of certain abnormal cervical cytology results in adults and adolescents
* Colposcopy of cervix: Colposcopy with endocervical assessment is recommended for select women with cervical cytologic abnormalities and cervical cancer precursors .
Abnormal cervical cytology
* Cervical biopsy: Cervical biopsy should be performed on any visible cervical lesion; endocervical sampling often is done in conjunction with colposcopy .
Diagnostic confirmation and possible treatment of cervical intraepithelial neoplasia 2 or 3, adenocarcinoma in situ, or microinvasive cervical cancer
* Cold knife cone biopsy of cervix: Cold knife conization is the preferred procedure for diagnostic confirmation and possible treatment of microinvasive cervical cancer and adenocarcinoma in situ .
Diagnostic confirmation and possible treatment of abnormal cervical cytology or noninvasive cervical intraepithelial neoplasia (CIN) 2 or 3
* Loop electrosurgical excision procedure: The LEEP may assist in the diagnosis of high-grade squamous intraepithelial lesion cytology results and is a treatment option for cervical intraepithelial neoplasia .
Suspected endometrial cancer
* Endometrial biopsy: Histological information obtained from the endometrial biopsy is generally sufficient for proceeding with definitive treatment .
Differential Diagnosis
* Uterine cancer - Acute
* Polyp of cervix
* Cervicitis
* Uterine leiomyoma - Chronic
Treatment
Drug Therapy
First-line chemotherapy for invasive cervical cancer
CISPLATIN
CARBOPLATIN
PACLITAXEL
TOPOTECAN HYDROCHLORIDE
Alternative first-line combination chemotherapy for cervical cancer (preferred therapy if cisplatin was previously used as a radiosensitizer)
CISPLATIN - PACLITAXEL
CISPLATIN - TOPOTECAN HYDROCHLORIDE
CISPLATIN - GEMCITABINE HYDROCHLORIDE
CARBOPLATIN - PACLITAXEL
Procedural Therapy
Diagnostic confirmation and possible treatment of cervical intraepithelial neoplasia 2 or 3, adenocarcinoma in situ, or microinvasive cervical cancer
* Cold knife cone biopsy of cervix: Cold knife conization is the preferred procedure for diagnostic confirmation and possible treatment of microinvasive cervical cancer and adenocarcinoma in situ .
Diagnostic confirmation and possible treatment of abnormal cervical cytology or noninvasive cervical intraepithelial neoplasia (CIN) 2 or 3
* Loop electrosurgical excision procedure: The LEEP may assist in the diagnosis of high-grade squamous intraepithelial lesion cytology results and is a treatment option for cervical intraepithelial neoplasia .
Treatment of abnormal cervical cytology or cervical intraepithelial neoplasia 2 or 3 when invasive disease has been ruled out
* Cryotherapy, Cervix uteri structure: Cryotherapy is a treatment option for women with cervical intraepithelial neoplasia 2 or 3 if colposcopy is satisfactory and invasive disease is ruled out .
Cervical intraepithelial neoplasia
* Laser excision of lesion of cervix
Treatment of patients with carcinoma in situ or invasive cervical cancer
* Hysterectomy: Total hysterectomy with or without salpingo-oophorectomy or radical hysterectomy with lymphadenectomy are options for carcinoma in situ and early-stage cervical cancer .
Invasive cervical cancer
* Radiation therapy: Radiotherapy is one of the primary treatment options for most stages of invasive cervical cancer .
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