Gynecologic Cancers: Cervical Cancer

Cervical cancer is the fourth most common gynecologic cancer worldwide and the second most common cancer during pregnancy. Globally, there are high incidence and mortality rates with this cancer, especially in developing countries. The incidence and death rate is not as high within the United States. However, given the preventability of this cancer, attention should be focused on identifying risk factors, prioritizing primary prevention, conducting screening and early detection, and performing tertiary prevention. The most common risk factor is the persistence of high-risk human papillomavirus infection, and vaccination should be encouraged. Cervical cancer screening methods include a cervical cytology test alone, a high-risk human papillomavirus test alone, or a combination of both known as cotesting. When an abnormal result is identified, American Society for Colposcopy and Cervical Pathology guidelines should be followed for management and follow-up. Most general gynecologists are unlikely to manage gynecologic malignancies; therefore, if a malignant lesion is identified, prompt referral to gynecologic oncology is required for management. Magnetic resonance imaging of the pelvis, computed tomography, and 18F-fluorodeoxyglucose positron emission tomography can help identify spread of the malignant lesion with other crucial prognostic factors. Management of cervical cancer depends on the stage of disease and the patient's desire for future fertility. Select patients with appropriate counseling can be candidates for fertility sparing options, if interested in childbearing. Treatment options can include surgery, radiation therapy, chemotherapy, immunotherapy, and targeted therapy. The 5-year survival rate is approximately 68.0% overall, but it ultimately depends on the cancer's stage. Given the type of treatment that is provided, survivorship care will require a multidisciplinary approach.