Resumen
Definición
Anamnesis y examen
Principales factores de diagnóstico
- abnormal vaginal bleeding
- postcoital bleeding
- pelvic or back pain
- dyspareunia
- cervical mass
- cervical bleeding
Otros factores de diagnóstico
- mucoid or purulent vaginal discharge
- bladder, renal, or bowel obstruction
- bone pain
Factores de riesgo
- human papillomavirus (HPV) infection
- age group
- HIV infection
- early onset of sexual activity (younger than 18)
- multiple sexual partners
- cigarette smoking
- immunosuppression
- in utero exposure to diethylstilbestrol
- history of STI
- oral contraceptive pill use
- high parity
- uncircumcised male partner
- micronutrient malnutrition
- low serum folate
- low vitamin C and E levels
- alcohol use
- low socioeconomic status
Pruebas diagnósticas
Primeras pruebas diagnósticas para solicitar
- vaginal or speculum examination
- colposcopy
- biopsy
- human papillomavirus (HPV) testing
Pruebas diagnósticas que deben considerarse
- CBC
- renal function testing
- liver function tests
- chest x-ray
- intravenous pyelogram
- renal ultrasound
- barium enema
- sigmoidoscopy
- cystoscopy
- MRI pelvis
- PET whole body
- PET/CT whole body
- CT of chest/abdomen/pelvis with intravenous/oral contrast
- molecular testing
Pruebas emergentes
- p16 and Ki67 biomarker expression
Algoritmo de tratamiento
nonpregnant stage IA1 without LVSI: desiring fertility
nonpregnant stage IA1 without LVSI: not desiring fertility
nonpregnant, stage IA1 with LVSI: desiring fertility
nonpregnant, stage IA1 with LVSI: not desiring fertility
nonpregnant stage IA2: desiring fertility
nonpregnant stage IA2: not desiring fertility
nonpregnant stage IB1: desiring fertility
nonpregnant stage IB1: not desiring fertility
nonpregnant stage IB2: desiring fertility
nonpregnant, stage IB2: not desiring fertility
nonpregnant stage IIA1
nonpregnant stage IB3 or IIA2
nonpregnant stage IIB to IVA
nonpregnant, stage IVB (metastatic disease)
nonpregnant local or regional recurrent disease
pregnant
Colaboradores
Autores
Richard T. Penson, MD, MRCP
Medical Gynecologic Oncologist
Division of Hematology Oncology
Massachusetts General Hospital
Boston
MA
Divulgaciones
RTP reports serving on scientific advisory boards for Aadi Bioscience, AstraZeneca, GSK Inc., ImmunoGen Inc., Merck & Co., Roche Pharma, Sutro Biopharma, Tubulis GmbH; and serves on or chairs data and safety monitoring boards for AstraZeneca, EQRx, and Roche Pharma. RTP receives institutional research funding (as Principal Investigator) from 858 Therapeutics; royalties from BMJ Publishing, UptoDate, Elsevier Ltd, Wolters Kluwer Health, and Wiley-Blackwell; and payment for educational events from Research to Practice, ExpertConnect, ReachMD, and CMEO Outfitters.
Andrea L. Russo, MD
Director
Gynecologic Radiation Oncology
Associate Clinical Director
Department of Radiation Oncology
Massachusetts General Hospital
Boston
MA
Divulgaciones
ALR declares that she has no competing interests.
Agradecimientos
Dr Richard T. Penson and Dr Andrea L. Russo would like to gratefully acknowledge Dr Larissa J. Lee, their co-contributor who is sadly deceased, and to acknowledge Dr Neil S. Horowitz and Dr Anthony H. Russell, previous contributors to this topic.
Divulgaciones
NSH and AHR declare that they have no competing interests.
Revisores por pares
Tracilyn Hall, MD
Assistant Professor of Gynecologic Oncology
Dan L Duncan Comprehensive Cancer Center
Baylor College of Medicine Houston
Houston
TX
Divulgaciones
TH declares that she has no competing interests.
Linda Yang, MD
Fellow
Minimally Invasive Gynecologic Surgery
Magee Women's Hospital
University of Pittsburgh Medical Center
PA
Divulgaciones
LY declares that she has no competing interests.
Deirdre Lyons, MB, BCh, BAO, MRCOG
Consultant in Obstetrics & Gynaecology
Lead Clinician in Colposcopy
Imperial College Healthcare NHS Trust
London
UK
Divulgaciones
DL declares that she has no competing interests.
Agradecimiento de los revisores por pares
Los temas de BMJ Best Practice se actualizan de forma continua de acuerdo con los desarrollos en la evidencia y en las guías. Los revisores por pares listados aquí han revisado el contenido al menos una vez durante la historia del tema.
Divulgaciones
Las afiliaciones y divulgaciones de los revisores por pares se refieren al momento de la revisión.
Referencias
Artículos principales
Marth C, Landoni F, Mahner S, et al. Cervical cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2017 Jul 1;28(suppl 4):iv72-83.Texto completo Resumen
Fontham ETH, Wolf AMD, Church TR, et al. Cervical cancer screening for individuals at average risk: 2020 guideline update from the American Cancer Society CA Cancer J Clin. 2020 Sep;70(5):321-46.Texto completo Resumen
Bhatla N, Aoki D, Sharma DN, et al. Cancer of the cervix uteri: 2021 update. Int J Gynaecol Obstet. 2021 Oct;155 Suppl 1(suppl 1):28-44.Texto completo Resumen
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: cervical cancer [internet publication].Texto completo
Artículos de referencia
Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
Diferenciales
- Human papillomavirus (HPV) infection
- Pelvic infection
- Nabothian cyst
Más DiferencialesGuías de práctica clínica
- NCCN clinical practice guidelines in oncology: cervical cancer
- Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV
Más Guías de práctica clínicaFolletos para el paciente
Cervical cancer
HPV (human papillomavirus) vaccine
Más Folletos para el paciente
Inicie sesión o suscríbase para acceder a todo el BMJ Best Practice
El uso de este contenido está sujeto a nuestra cláusula de exención de responsabilidad