Watford General Hospital West

Watford, United Kingdom

Watford General Hospital West

Watford, United Kingdom

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Kyrgiou M.,Watford General Hospital West | Kyrgiou M.,University of Cambridge | Shafi M.I.,Watford General Hospital West | Shafi M.I.,University of Cambridge
Obstetrics, Gynaecology and Reproductive Medicine | Year: 2010

Invasive cervical cancer remains the second most common malignancy affecting women worldwide. Early-stage disease may be asymptomatic. Advances in imaging techniques have improved selection of the appropriate treatment modality. Treatment options vary for each stage. Cone biopsy is sufficient for treatment of micro-invasive disease (Ia1) provided the margins are clear. The management of stage Ia2 disease is more controversial. Surgery and radiation have similar survival rates for stages Ib-IIa disease, while the combination of both increases morbidity. Later stage tumours (IIb-IV) should be treated with chemo-radiation as it appears to improve survival but also toxicity in comparison to radiotherapy alone. More recent fertility-sparing surgical techniques such as radical trachelectomy may be appropriate in selected cases. Management of recurrent disease depends on the initial treatment modality used, the individual characteristics and the presence of distant disease. Management of cervical cancer during pregnancy remains a challenge and appropriate counselling on individual patient basis is necessary. As the disease usually affects young women, psychological morbidity is significant and emotional support is essential. © 2010 Elsevier Ltd. All rights reserved.


Kyrgiou M.,Watford General Hospital West | Kyrgiou M.,University of Cambridge | Shafi M.I.,Watford General Hospital West | Shafi M.I.,University of Cambridge
Obstetrics, Gynaecology and Reproductive Medicine | Year: 2010

Cervical cancer is both preventable and curable. It has a long natural history with a prolonged pre-cancerous phase that is easily detectable and treatable. Exfoliative cytology remains the mainstay for screening of pre-cancerous lesions. Assessment of women presenting with abnormal cervical cytology and the selection of those requiring treatment relies mainly on colposcopic impressions of the cervical transformation zone and histological appraisal of directed punch biopsies. There is variation in the assessment of cytology, colposcopy and histology findings, and therefore the 'final' diagnosis involves of all three disciplines. The need to maximize clinical resources, achieve quicker and more effective management of patients, limit post-operative complications and preserve reproductive function has led to the popularity of local excisional methods for cervical pre-malignancy. Although the cure rates for all local ablative and excisional methods are more than 90% after one treatment, the excisional methods provide a more reliable histopathological diagnosis and the patient may be treated at the initial visit. Cure rates for correlate principally with the extent of the cervical intra-epithelial neoplasia (CIN). The recognition that persistent infection with oncogenic HPV causes cervical cancer has stimulated the search for preventative vaccines. Those vaccines are now available for use and appear to be safe, well tolerated and highly efficacious in HPV naive women. The national HPV immunization programme with the bivalent vaccine was initiated in the NHS in September 2008. © 2010 Elsevier Ltd. All rights reserved.

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