Cancer of the cervix uteri: 2025 update

Since the publication of the 2021 FIGO Cancer Report, there has been further progress in the global effort to attain the WHO goal of cervical cancer elimination using a three-pillar approach of vaccination, screening, and treatment. The HPV vaccination is now included in the national program of over 140 countries. Two-dose schedules are being implemented in 80 countries and one-dose schedules in 60 countries. Screening has seen major advances with the wider implementation of HPV testing, including the option of self-sampling, portable screening and treatment devices, and the incorporation of artificial intelligence. Diagnostic accuracy is being enhanced with immunohistochemistry and receptor assays. Surgical treatment of invasive cancer is being revolutionized with the possibility of conservative surgery in very early stages, minimizing complications and adverse effects and offering feasibility of fertility sparing. New data on minimally invasive surgery are redefining the role of laparoscopy and robotic surgery in early stages with small tumor size. Sentinel lymph node evaluation is an emerging alternative to complete lymphadenectomy. Immunotherapy has opened up new possibilities for the management of recurrent and metastatic disease. This chapter discusses the management of cervical cancer based on the stage of disease, including attention to palliation and quality-of-life issues, with insights into the results from recent landmark trials.