INTRODUCTION
Cancer of the cervix is the third most common cancer among women worldwide with an estimated 569,847 new cases and 311,365 deaths in 2018. About 85% of the new cases and 90% of deaths occur in low resource regions or socioeconomically weaker sections of the society.(1)
Cervical cancer ranks as the 2nd most frequent cancer in the Philippines and the 2nd most frequent cancer among women between 15 and 44 years of age. In 2018, about 7,190 new cervical cancer cases were diagnosed annually while 4,088 cases led to death.(2) According to the Philippine Cancer Facts and Estimates, the incidence of cervical cancer among Filipino women starts rising steeply at age 30 with an annual age standardized incidence of 16 per 100,000 women and mortality rate of 7.5 per 100,000.(3)
About 2/3 of cervical cancer in the Philippines are diagnosed in an advanced stage, leading to a high mortality rate. Furthermore, a significant proportion of patients do not receive or complete the prescribed courses of treatment, due to inadequacies in treatment availability, accessibility and affordability.
Society of Gynecologic Oncology: Clinical Practice Guidelines for Obstetrician – Gynecologists
DIAGNOSIS AND MANAGEMENT OF CERVICAL CANCER
A. How is cervical cancer diagnosed?
RECOMMENDATION:
- Cervical biopsy should be done in patients with a cervical mass highly suspicious for malignancy
Quality of evidence: 5
Strength of recommendation: B
RECOMMENDATION:
- Cone biopsy through conization or loop electrosurgical excison procedure should be done if the cervical biopsy is inadequate to detemine invasiveness.
Quality of evidence: 3b
Strength of recommendation: C
B. What diagnostics work-up should be requested for patients diagnosed with cervical cancer?
RECOMMENDATION:
- Patients diagnosed with cervical cancer should undergo the following laboratory tests: complete blood count, platelets, liver function and renal function tests.
Quality of evidence: 5
Strength of recommendation: C
RECOMMENDATION:
- Radiologic imaging studies like chest x-ray, ultrasound, CT scan, PET CT scan, MRI and bone scintigraphy should be dine as indicated.
Quality of evidence: 3b
Strength of recommendation: B
RECOMMENDATION:
- Cystoscopy and proctoscopy should be done for patients with possible bladder or rectal invasion.
Quality of evidence: 5
Strength of recommendation: B
C. How should patients diagnosed with cervical cancer be managed?
RECOMMENDATION:
- Patients with cervical carcinoma should be managed with either surgery and radiotherapy concurrent with chemotherapy. Surgery is performed for early staged disease and those with small tumors such as Stage 1A, 1B1, and selected IIA1 cases
Quality of evidence: 2 a
Strength of recommendation: B
RECOMMENDATION:
- Fertility sparing treatments may be done in selected patients who have been properly and thoroughly informed of diseases risks and perinatal issues.
Quality of evidence: 2a
Strength of recommendation: B
RECOMMENDATION:
- Total Abdominal Hysterectomy with Bilateral Salpingo-oophorectomy should not be done among patients diagnosed with cervical cancer.
Quality of evidence:
Strength of recommendation:
Table 1. Non-fertility Sparing Treatment for Cervical Cancer (NCCN)
