Abstract
Cervical cancer (CC) is the fourth most common cancer in women worldwide, strongly linked to high-risk human papilloma virus infection. In high-income countries, the screening programs have dramatically decreased the incidence of CC; however, the lack of accessibility to them in developing countries makes CC an important cause of mortality. Clinical stage is the most relevant prognostic factor in CC. The new FIGO staging system published in 2018 is more accurate than the previous one since it takes into account the lymph node status. In early stages, the primary treatment is surgery—with some concerns recently raised regarding minimally invasive surgery because it might decrease survival—or radiotherapy, whereas concomitant chemo-radiotherapy is the conventional approach in locally advanced stages. For recurrent or metastatic CC, the combination of chemotherapy plus bevacizumab is the preferred therapy. Immunotherapy approach based on checkpoint inhibitors is evolving as the election therapy following failure to platinum therapy.
Highlights
CC represents a unique disease, due to the presence of wellknown risk factors, a very well-established etiologic agent, namely HPV infection, a long pre-invasive period which allows the use of screening tests and the availability of effective preventive vaccination [1]
The disease-free survival (DFS) at 4.5 years of minimally invasive surgery (MIS) arm was 86.0% compared with 96.5% for open surgery arm
The initial positive results were definitely demonstrated in the Cochrane individual patient meta-analysis of 13 trials [14] with an improvement in CRT of 10% and 13% in absolute 5-year overall survival (OS) and disease-free survival (DFS), respectively
Summary
CC represents a unique disease, due to the presence of wellknown risk factors, a very well-established etiologic agent, namely HPV infection, a long pre-invasive period which allows the use of screening tests and the availability of effective preventive vaccination [1]. HPV-16 and HPV-18 are responsible for 70% of squamous carcinomas and 90% of adenocarcinomas. The majority of women will clear the HPV infection during the following 2 years after the primo infection, in some of them HPV will persist, leading to the development of a pre-malignant lesion and eventually an invasive CC 15–20 years after the first infection. Vaccines against HPV have demonstrated a clear reduction in the development of pre-invasive lesions. Even with well-established screening programs, women could develop CC. Treatment approaches for women affected by invasive CC are presented in these guidelines
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