Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- abnormal vaginal bleeding
- postcoital bleeding
- pelvic or back pain
- dyspareunia
- cervical mass
- cervical bleeding
Outros fatores diagnósticos
- mucoid or purulent vaginal discharge
- bladder, renal, or bowel obstruction
- bone pain
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
- 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
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- vaginal or speculum examination
- colposcopy
- biopsy
- human papillomavirus (HPV) testing
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
Novos exames
- p16 and Ki67 biomarker expression
Algoritmo de tratamento
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
Declarações
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
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
Declarações
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
Declarações
DL declares that she has no competing interests.
Créditos aos pareceristas
Os tópicos do BMJ Best Practice são constantemente atualizados, seguindo os desenvolvimentos das evidências e das diretrizes. Os pareceristas aqui listados revisaram o conteúdo pelo menos uma vez durante a história do tópico.
Declarações
As afiliações e declarações dos pareceristas referem--se ao momento da revisão.
Referências
Principais artigos
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 Resumo
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 Resumo
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 Resumo
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: cervical cancer [internet publication].Texto completo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
Diagnósticos diferenciais
- Human papillomavirus (HPV) infection
- Pelvic infection
- Nabothian cyst
Mais Diagnósticos diferenciaisDiretrizes
- NCCN clinical practice guidelines in oncology: cervical cancer
- Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV
Mais DiretrizesFolhetos informativos para os pacientes
Cervical cancer
HPV (human papillomavirus) vaccine
Mais Folhetos informativos para os pacientes
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