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6. Follow-up

Surveillance after primary curative therapy for cervical cancer is recommended, although its effectiveness is not well studied.

  1. To determine the patient's immediate response to the treatment employed 
  2. Early recognition and prompt management of treatment related complications 
  3. Early detection of persistent or recurrent disease 
  4. Collection of meaningful data regarding the efficacy of existing treatment policies and their complications so that any appropriate modifications can be instituted 
In 2016, consensus-based surveillance recommendations were updated by the Program in Evidence-Based Care of Cancer Care Ontario Cervical Cancer Follow-up Guideline Working Group, following review and analysis of the literature.  A reasonable surveillance strategy involves clinic visits at the following intervals:

Years 1-2every 3-4 months
Years 3-5every 6-12 months
Years 5+annually

Follow-up visits should include history and complete physical examination.  Physical examination should include bimanual, pelvic and rectal examination as well as speculum examination.

If vaginal vault cytology is used to detect new precancerous conditions of the vagina, it should be performed no more frequently than once annually.  An abnormal cytology result that suggests the possibility of neoplasia warrants colposcopic evaluation and directed biopsy.  It is important to note that the accuracy of cervicovaginal cytology is compromised by the anatomic and tissues changes resulting from pelvic radiation. Cytology follow-up is not recommended for patients who have been treated with radiotherapy.

In the absence of concerning symptoms or signs, other investigations such as imaging and blood work, including tumor markers, are not advocated.

Repeat PET-scan could be considered at 3-6 months after completion of the treatment. The validity of PET-scan after completion of radiochemotherapy is still being evaluated.  Some of the indications for PET-scan include:
  • Evaluation of possible residual disease on clinical examination
  • Evaluation of residual abnormal signal on post-treatment MRI
  • Evaluation of progressive disease amenable to salvage treatments
Initial follow-up is performed by BC Cancer medical staff but when appropriate, arrangements will be made for surveillance by the referring or family physician.

References

  1. Elit L, et al. Follow-up for cervical cancer: a Program in Evidence-Based Care systematic review and clinical practice guideline update. Curr Oncol 2016;23(2):109-118.

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