Diagnostics and therapy of cervical cancer

Cervical cancer is the third most common genital cancer in women in Germany. The choice of treatment depends on tumor stage, risk factors and individual patient characteristics. Cervical cancer is clinically classified according to the F,d,ration Internationale de Gyn,cologie et d'Obst,trique (FIGO) stage. For this a clinical examination is necessary with the use of a speculum, bimanual vaginal and rectal examination, a gynecological examination with removal of material for cytological diagnostics and human papillomavirus (HPV) testing as well as a targeted biopsy by colposcopy or conization. Additionally, special diagnostics include an obligatory gynecological ultrasound investigation and renal sonography and further imaging methods can be helpful in uncertain situations and high-grade tumor stages. Lymph node staging is carried out for all patients with tumor stage FIGO IA2 and higher. Up to tumor stages FIGO IB-IIB, radical hysterectomy combined with pelvic and if necessary para-aortic lymph node staging are performed. Chemoradiotherapy leads to similar results compared to open surgery regarding long-term survival but differs in the side-effect profile and recurrence pattern. Sentinel lymph node dissection is being tested in clinical trials. For patients suffering from locally advanced cancer FIGO stage III primary chemoradiotherapy is recommended and for patients with FIGO stage IV tumors individual treatment should be considered. Adjuvant chemoradiotherapy is conducted in high risk patients. In advanced FIGO stage IVb and recurrent cervical cancer primary chemotherapy represents the therapeutic option. By adequate diagnostics and therapy decisions over-therapy and under-therapy can be avoided and the optimal treatment for each stage can be found. For the corresponding early tumor stage a fertility-retaining treatment is possible. In this way even comorbidities can be avoided as far as possible by a combination of therapeutic procedures.