Cervical Cancer Posttreatment Follow-up: Critical Analysis
Ingrid Hillesheim1, Gabriel Augusto Limone, Lucia Klimann
1Faculty of Health Science of Barretos Paulo Prata M.D., Barretos, São Paulo, Brazil.
Objective:
The aim of this study was to evaluate the role of follow-up tests and examinations in diagnosing symptomatic and asymptomatic relapses after treatment for cervical cancer.
Methods:
Data were collected from medical records for all patients diagnosed as having cervical cancer from January 1985 to June 2010. The significance level was P < 0.005.
Results:
Sixty-four (17.8%) of the 358 patients investigated suffered tumor relapse. Thirty-four (53.1%) were symptomatic, and 30 (46.9%) were asymptomatic. Most patients had tumor relapse diagnosed during physical examination, both among the symptomatic patients (50%) and the asymptomatic patients (66.7%) (P = 0.27). Cytopathology was responsible for detecting relapse in only 1 case in each group, corresponding to 2.9% and 3.3%, respectively (P = 0.99). Imaging examinations confirmed 10 relapses (29.4%) among symptomatic patients and 8 cases (26.6%) among asymptomatic patients (P = 0.77). There were no statistically significant differences between the 2 groups or between the different methods of detecting relapses. There was still no association after adjustment for potential confounding factors such as age and type of treatment.
Conclusions:
Physical examination was the preeminent method for detecting tumor relapse in this study. None of the other tests or examinations were capable of detecting relapses in both symptomatic and asymptomatic patients. These results highlight the urgent need for prospective studies that compare the efficacy of different follow-up regimens, analyzing factors such as global survival, quality of life, and cost.
