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S
adalla
JC
et
al
.
536
R
ev
A
ssoc
M
ed
B
ras
2015; 61(6):536-542
REVIEW ARTICLE
Cervical cancer: what’s new?
J
osé
C
arlos
S
adalla
1
*, J
urandyr
M
oreira
de
A
ndrade
2
, M
aria
L
uiza
N
ogueira
D
ias
G
enta
3
, E
dmund
C
hada
B
aracat
4
1
PhD Assistant Professor, Mastology Sector, Division of Gynecology, Department of Obstetrics and Gynecology and the Institute of Cancer of the State of São Paulo, Hospital das Clínicas, Faculdade de Medicina,
Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
2
Full Professor at the Department of Gynecology and Obstetrics, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
3
Assistant Professor, Mastology Sector, Division of Gynecology, Department of Obstetrics and Gynecology and the Institute of Cancer of the State of São Paulo, Hospital das Clínicas, FMUSP, São Paulo, SP, Brazil
4
Full Professor, Division of Gynecology, Department of Obstetrics and Gynecology, FMUSP, São Paulo, SP, Brazil
S
ummary
Study conducted at the Mastology Sector,
Division of Gynecology, Department of
Obstetrics and Gynecology, and the
Institute of Cancer of the State of São
Paulo, Hospital das Clínicas, Faculdade
de Medicina, Universidade de São Paulo
(FMUSP), São Paulo, SP, and the Sector of
Mastology and Gynecologic Oncology at
Faculdade de Medicina de Ribeirão Preto
(HCRP), Ribeirão Preto, SP, Brazil
Article received:
10/20/2015
Accepted for publication:
10/23/2015
*Correspondence:
Address: Av. Ibirapuera, 2907, cj. 720,
Indianópolis
Postal code: 04029-200
São Paulo, SP – Brazil
jcsadalla@gmail.com http://dx.doi.org/10.1590/1806-9282.61.06.536Financial support:
none
Cervical cancer is the most common gynecological cancer in Brazil. Among wom-
en, it is the second most frequent, second only to breast cancer. It is the fourth
leading cause of cancer death in the country, with estimated 15,590 new cases
(2014) and 5,430 deaths (2013). In order to update information to improve out-
comes, reduce morbidity and optimize the treatment of this cancer, this article
will address the advancement of knowledge on cervical cancer. The topics cov-
ered include the role of surgery in different stages, treatment of locally advanced
carcinomas, fertility preservation, the role of the sentinel lymph node technique,
indications and techniques of radiotherapy and chemotherapy, and some spe-
cial situations.
Keywords:
cancer, cervix, pelvic exenteration, fertility sparing, sentinel lymph
node biopsy, brachytherapy, chemotherapy.
I
ntroduction
Cervical cancer is the most frequent pelvic cancer among
women in Brazil. In the gynecological sphere, it is the sec-
ond most frequent, immediately after breast cancer. It is
the fourth leading cause of cancer death in the country,
with estimated 15,590 new cases (2014) and 5,430 deaths
(2013).
1
Treatment of cervical cancer is planned depending
on the clinical stage of the disease, ranging from surgery
alone to a combination of radiation, chemotherapy and
surgery in special situations. However, the side effects
and morbidity caused by these therapies often deeply af-
fect the quality of life of patients. Another important
point is that the staging of cervical cancer is done clini-
cally, including the results of imaging tests, and the ini-
tial classification should not be changed depending on
surgical findings. The most recent classification of cervi-
cal cancer stages by the International Federation of Gy-
necology and Obstetrics (Figo) is shown in Table 1.
In order to provide important information to better
assist the patients, reducing the morbidity and optimiz-
ing the treatment of this malignancy, this article will ad-
dress recent advances of knowledge on cervical cancer.
The topics selected include the role of surgery in differ-
ent stages, fertility preservation, the role of the sentinel
lymph node technique, indications and techniques for
radiotherapy and chemotherapy, and also some special
situations.
T
he
role
of
surgery
in
the
initial
stages
Surgery as treatment alone is employed for the initial
stages (carcinoma
in situ
, micro-invasive, and invasive stage
IB1), but depending on the diameter of the lesion, some
centers treat IIA1 cancers surgically. However, this ap-
proach is not recommended as initial therapy of IB2 tu-
mors (limited to the cervix and having a diameter above
4 cm).
2-5
For lesions in stage 0 (
in situ
carcinoma), coniza-
tion with free margins is sufficient.
2-5
In stage IA1 (micro-invasion less than 3 mm), the
choice will depend on the patient’s desire to preserve fer-
tility, and whether there is lymphovascular invasion. Af-
ter conization, if the cone margins are free and there is
no lymphovascular invasion, clinical monitoring alone
is recommended. It is recommended to avoid fragmenta-