Foreword
The annual academic event “2022 CSCO Guide Meeting” will be held on April 23-24, 2022 as scheduled During the meeting, well-known experts and professors from various tumor fields in China gathered to interpret and discuss the 2022 CSCO Guidelines. At this meeting, Professor An Jusheng from Cancer Hospital, Chinese Academy of Medical Sciences shared the progress of cervical cancer diagnosis and treatment. Edited by Yimaitong as follows.
Expert profile
Deputy Chief Physician of Cancer Hospital, Chinese Academy of Medical Sciences
Member of the Chinese Society of Clinical Oncology (CSCO) Gynecological Oncology Expert Committee
China Anti-Cancer Young member of the Gynecological Oncology Professional Committee of the Association
Beijing Medical Award Foundation Gynecological Oncology Professional Committee Standing Committee
Young Committee Member of Beijing Medical Association Gynecological Oncology Society
Fan Jingjinji Gynecological Oncology Branch of Beijing Medical Association Radiation Oncology Branch Member of the Multicenter Professional Collaboration Group
Cervical cancer is the most common female genital tract malignant tumor in women. According to the 2020 WHO-IARC report, there were 604,127 new cervical cancer cases (3.1%) and 341,831 deaths (3.3%) worldwide, including 109,741 new cases and 59,060 deaths in China. Standardizing cervical cancer prevention, diagnosis and treatment in China is a key issue in promoting the construction of a healthy China and improving women’s health. The CSCO Cervical Cancer Guidelines will draw on a number of foreign authoritative guidelines, combined with the characteristics of cervical cancer disease in my country, the latest clinical research and results, as well as the experience of previous guideline compilation and the clinical experience of fellow experts, and will be maintained every year. Update once, keep pace with the times.
Cervical Cancer Diagnosis
Imaging
Pelvic MRI is the first choice to evaluate local lesions, and systemic tumor needs to be evaluated. In addition, according to the symptoms and the clinical possibility of distant metastasis, other imaging examinations were performed as appropriate.
Pathology
The pathological diagnosis was primary cervical cancer The gold standard for diagnosis. The CSCO guidelines will classify the pathological diagnosis according to the WHO 2020 fifth edition of the classification of female genital tumors. As a supplement to the new classification system for adenocarcinoma (2020NCCN), the International Classification of Cervical Adenocarcinoma (IECC) and silva classification are of great significance for judging the prognosis of cervical adenocarcinoma and formulating treatment plans. The new molecular pathological diagnosis (2022NCCN) recommends the detection of PD-L1, MMR/MSI, and TMB in recurrent, advanced or metastatic cervical cancer, which is helpful to know the individualized treatment of recurrent and metastatic cervical cancer.
Cervical Cancer Staging
Using the latest 2018 The FIGO staging system for cervical cancer, based on clinical staging, uses imaging and pathology to supplement the staging information of lymph node metastasis, which can more effectively guide the treatment and prognosis of cervical cancer.
Treatment strategies for newly diagnosed cervical cancer
Mainly with surgery and radiotherapy, supplemented by chemotherapy, targeted, immune and other treatments;
early cervical cancer ( IA-II A) surgery is the main option;
radiotherapy is suitable for all stages of cervical cancer, and concurrent chemoradiotherapy is for locally advanced cervical cancer (IB3, IIA2, IIB-IVA) standard treatment;
according to the stage, pathology, general condition of the patient, age and other factors to formulate individualized treatment Program.
Strategies for the treatment of stage IA-IIA cervical cancer
It should be noted that
stage IA2 or IB1 (diameter ≤ 2cm) after strict screening can be Choose transvaginal radical trachelectomy + PLND (considering SLN imaging), the same as type B radical hysterectomy; strictly screened stage IB1-IB2 (diameter 2-4cm), open radical trachelectomy, Similar to radical hysterectomy type C; fertility-sparing surgery is not recommended for small cell neuroendocrine tumors, gastric-type adenocarcinoma, and malignant adenoma (minimally biased adenocarcinoma).
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Minimally invasive surgery is associated with lower DFS and OS compared with open radical hysterectomy, according to a prospective randomized controlled study; criteria for radical hysterectomy The surgical approach is an open approach (category 1);
for patients with neoadjuvant chemotherapy combined with surgery, FIGO And ESMO guidelines pointed out that neoadjuvant chemotherapy is used in clinical research or areas lacking radiotherapy equipment, and if it is ineffective, it should be transferred to concurrent chemoradiotherapy; neoadjuvant chemotherapy may change the pathological results and thus affect the evaluation of adjuvant radiotherapy/concurrent radiotherapy and chemotherapy indications; new The application of adjuvant chemotherapy is not supported by high-level evidence-based medicine.
Early Adjuvant Treatment Standards for Postoperative Cervical Cancer
It should be noted that
For patients with high risk factors, platinum-based synchronization should be selected Chemotherapy (category 1), and cisplatin is the first choice, and carboplatin is used for those who cannot tolerate it;
For patients with intermediate risk factors, not only Limited to Sedlis factors, adenocarcinoma components and insufficient margins should also be considered, and postoperative adjuvant therapy should also be performed;
RTOG0418 and PACER Studies have shown that postoperative adjuvant radiotherapy, treatment planning based on CT three-dimensional images and conformal blocks (conformal intensity modulated technology) are the standard for external pelvic radiotherapy to reduce the side effects of radiotherapy in the bowel and urogenital tract.
Strategies for the treatment of stage IIB-IVA cervical cancer
It should be noted that
- < p>Clinical studies of para-aortic lymph node involvement are ongoing to compare surgical versus imaging staging.
Radical radiotherapy for cervical cancer includes external irradiation and brachytherapy;
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platinum-based concurrent chemoradiotherapy (category 1), cisplatin is the first choice, and carboplatin is used for those who cannot tolerate it; p>
Proposed image-guided 3D afterloading therapy technique and dose assessment system (ICRU89, EMBRACE study 2016-2022);< /p>
Those who complete the treatment within 8 weeks have the best results.
Therapeutic strategies for stage IVB or recurrent cervical cancer with distant metastasis
Treatment strategies for local/regional recurrence of cervical cancer
It should be noted that
the patient’s previous treatments;
Relationship with the position of the radiotherapy field;
whether it is a central lesion.
Follow-up
It is important to note that
annual cervical/vaginal cytology as indicated to detect lower genitalia tract epithelial lesions
Education of patients, including scientific sexual health education (vaginal dilator use, lubricants/moisturizers, and hormone replacement therapy)
Editor: Uni
Reviewer: Professor An Jusheng
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Type: Uni
Execution: XY
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