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Cervical cancer

  • Overview
  • Theory
  • Diagnosis
  • Management
  • Follow up
  • Resources
Last reviewed: 16 Aug 2025
Last updated: 14 Feb 2025

Summary

Definição

História e exame físico

Principais fatores diagnósticos

  • abnormal vaginal bleeding
  • postcoital bleeding
  • pelvic or back pain
  • dyspareunia
  • cervical mass
  • cervical bleeding
Detalhes completos

Outros fatores diagnósticos

  • mucoid or purulent vaginal discharge
  • bladder, renal, or bowel obstruction
  • bone pain
Detalhes completos

Fatores de risco

  • human papillomavirus (HPV) infection
  • age group
  • HIV infection
  • early onset of sexual activity (younger than 18)
  • multiple sexual partners
  • cigarette smoking
  • immunosuppression
  • 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
Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • vaginal or speculum examination
  • colposcopy
  • biopsy
  • human papillomavirus (HPV) testing
Detalhes completos

Investigações a serem consideradas

  • 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
Detalhes completos

Novos exames

  • p16 and Ki67 biomarker expression

Algoritmo de tratamento

AGUDA

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
Richard T. Penson

Clinical Director

Medical Gynecologic Oncology

Division of Hematology Oncology

Massachusetts General Hospital

Boston

MA

Declarações

RTP reports serving on scientific advisory boards for AstraZeneca, Eisai, GSK Inc., ImmunoGen Inc., Merck & Co., Mersana, Novocure, Roche Pharma, Sutro Biopharma, Vascular Biogenics Ltd; data and safety monitoring boards for AstraZeneca and Roche Pharma; institutional research funding (as Principal Investigator) for Array BioPharma Inc., AstraZeneca, Eisai Inc., Genentech Inc., Regeneron, Sanofi-Aventis US LLC, Tesaro Inc., Vascular Biogenics Ltd; and royalties from BMJ Publishing, UptoDate, Elsevier Ltd, Wolters Kluwer Health, and Wiley-Blackwell.

Andrea L. Russo, MD

Director

Gynecologic Radiation Oncology

Associate Clinical Director

Department of Radiation Oncology

Massachusetts General Hospital

Boston

MA

Declarações

ALR declares that she has no competing interests.

Agradecimentos

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.

Declarações

NSH and AHR declare that they have no competing interests.

Revisores

Tracilyn Hall, MD

Assistant Professor of Gynecologic Oncology

Dan L Duncan Comprehensive Cancer Center

Baylor College of Medicine Houston

Houston

TX

Declarações

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

利益声明

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

利益声明

DL declares that she has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

参考文献

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

关键文献

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.全文  摘要

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.全文  摘要

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.全文  摘要

National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: cervical cancer [internet publication].全文

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

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