Follow-Up for Cervical Cancer: A Program in Evidence-Based Care Systematic Review and Clinical Practice Guideline Update

Abstract

BackgroundIn 2009, the Program in Evidence-based Care (pebc) of Cancer Care Ontario published a guideline on

Cervical Cancer Posttreatment Follow-up

“…The latest review that we found suggests that the cytopathology examination should be performed after the first 5 years of primary treatment. 8 Approximately 50% of patients with recurrent cervical cancer are diagnosed when the disease relapses during the first year of follow-up, and 75% are diagnosed by the end of the second year. Early diagnosis can have an impact on those recurrences that may be curable, such as local/central relapses after chemoradiation involving the cervix, vagina, bladder, rectum, and/or parametrium, which can be treated with pelvic exenteration, or asymptomatic pulmonary recurrences that appear to have favorable prognosis after treatment with surgery.…”

“…Magnetic resonance imaging has high specificity for detection of recurrent disease, but changes after early irradiation remain a problem, and it appears that positron emission tomography may be useful for increasing specificity and sensitivity, when screening for relapse in such cases. 15 Considering some of the latest guidelines, 8 if performed only complete physical examination and cytology once a year on the whole sample (n = 359), the costs would have been R$ 2383.76 (US $707.23) and would have diagnosed 39 relapses of the 64 (60.93% of the relapses). If we add chest x-rays as an annual examination, the costs increase to R$5759.74 (US $1708.84), but x-rays diagnose only 4 (67.18%).…”

Should we search for high-risk HPV in vaginal vault Pap smear after hysterectomy due to CIN2+?

“…However, it is also recommended that an abnormal cytology result suggesting the possibility of vaginal neoplasia warrants colposcopic evaluation and directed biopsy for histologic confirmation [25]. Some authors also suggest that the yearly vaginal Pap smear should be limited to the first five years after treatment without recurrence [26]. Orr et al found no cases of cancer in the 61 women studied for recurrence with vaginal Pap smears for 143 months after the five-year period of active surveillance, confirming the futility of Pap testing during this period [27].…”

SEOM clinical guidelines for cervical cancer (2019)

“…Although the routine use of imaging tests such as CT scan or PET-CT has yet to be evaluated in a definitive manner, they are usually performed in the daily practice in either high-risk patients or if clinically indicated. (Level of evidence II, Grade of recommendation B) [30]. A reasonable follow-up schedule involves follow-up visits every 3-6 months in the first 2 years and every 6-12 months in years 3-5.…”