Summary
Definition
History and exam
Key diagnostic factors
- presencia de factores de riesgo
- sangrado vaginal anormal
- sangrado poscoital
- dolor pélvico o de espalda
- dispareunia
- masa en el cuello uterino
- sangrado en el cuello uterino
Other diagnostic factors
- flujo vaginal mucoide o purulento
- obstrucción renal, intestinal o de vejiga
- dolor óseo
Risk factors
- infección por el virus del papiloma humano (VPH)
- grupo etario
- Infección por VIH
- inicio precoz de la actividad sexual (menores de 18 años)
- múltiples parejas sexuales
- tabaquismo
- inmunosupresión
- antecedentes de enfermedades de transmisión sexual (ETS)
- uso de píldora anticonceptiva oral
- elevada cantidad de partos
- pareja masculina no circuncidada
- desnutrición por carencia de micronutrientes
- niveles bajos de folato sérico
- niveles bajos de vitaminas C y E
- consumo de alcohol
- bajo nivel socioeconómico
Diagnostic investigations
1st investigations to order
- examen vaginal o con espéculo
- colposcopia
- biopsia
- pruebas del virus del papiloma humano (VPH)
Investigations to consider
- hemograma completo (HC)
- prueba de función renal
- pruebas de función hepática
- radiografía de tórax
- pielograma intravenoso
- ultrasonido renal
- enema de bario
- sigmoidoscopia
- cistoscopia
- resonancia magnética (IRM) de pelvis
- tomografía por emisión de positrones (TEP) de cuerpo entero
- tomografía por emisión de positrones/tomografía computarizada (TEP-TC) de cuerpo entero
- exploración por tomografía computarizada (TC) de tórax/ abdomen/pelvis con contraste por vía intravenosa y oral
- pruebas moleculares
Emerging tests
- Expresión de biomarcadores p16 y Ki67
Treatment algorithm
no embarazada en etapa IA1 sin LVSI: con deseo de fertilidad
no embarazada en etapa IA1 sin LVSI: sin deseo de fertilidad
no embarazada en etapa IA1 con LVSI: con deseo de fertilidad
no embarazada, etapa IA1 con LVSI: sin deseo de fertilidad
no embarazada, etapa IA2: con deseo de fertilidad
no embarazada, etapa IA2: sin deseo de fertilidad
no embarazada, etapa IB1: con deseo de fertilidad
no embarazada, etapa IB1: sin deseo de fertilidad
no embarazada, etapa IB2: con deseo de fertilidad
no embarazada, etapa IB2: sin deseo de fertilidad
no embarazada, etapa IA1:
no embarazada, etapa IB3 o IIA2
no embarazada, etapa IIB a IVA
no embarazada, etapa IVB (enfermedad metastásica)
no embarazada, enfermedad recurrente local o regional
embarazadas
Contributors
Authors
Richard T. Penson, MD, MRCP
Clinical Director
Medical Gynecologic Oncology
Division of Hematology Oncology
Massachusetts General Hospital
Boston
MA
Disclosures
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
Disclosures
ALR declares that she has no competing interests.
Acknowledgements
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.
Disclosures
NSH and AHR declare that they have no competing interests.
Peer reviewers
Tracilyn Hall, MD
Assistant Professor of Gynecologic Oncology
Dan L Duncan Comprehensive Cancer Center
Baylor College of Medicine Houston
Houston
TX
Disclosures
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
Disclosures
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
Disclosures
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.
References
Key articles
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.Full text Abstract
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.Full text Abstract
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.Full text Abstract
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: cervical cancer [internet publication].Full text
Reference articles
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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