Clinical Overview of Cervical Cancer: Screening, Treatment, and Future Directions

Introduction: This summary provides a concise review of a comprehensive guideline on cervical cancer, covering its epidemiology, risk factors, clinical presentation, and current therapeutic strategies. The aim is to highlight best practices for prevention, screening, and management, as well as emerging treatments that may shift the standard of care.

Key Recommendations:

1. Prevention and Screening
   • Encourage HPV vaccination before exposure, ideally in adolescence.
   • Perform regular screening with a Papanicolaou test, HPV testing, or both, based on national guidelines.
   • Use colposcopy and directed biopsies for women with abnormal screening results.
2. Early-Stage Disease (FIGO IA to IB2)
   • Offer radical hysterectomy plus pelvic lymphadenectomy; ovarian preservation may be considered for endocrine benefits.
   • Less radical surgery (simple hysterectomy or conization) is now acceptable for smaller tumors (<2 cm) confirmed by imaging and pathology.
   • In selected cases, fertility-sparing radical trachelectomy can be considered, though the SHAPE trial supports more conservative approaches for certain early tumors.
3. Locally Advanced Disease (FIGO IB3 to IVA)
   • Recommend concurrent chemoradiation therapy (daily external-beam radiotherapy, brachytherapy, and weekly cisplatin).
   • Immunotherapy (pembrolizumab) is approved in combination with chemoradiation for FIGO III to IVA disease, demonstrating improved survival.
   • Ensure treatment completion within optimal time frames to maximize therapeutic efficacy.
4. Pelvic Exenteration
   • Consider total pelvic exenteration for isolated central recurrence in patients without distant disease.
   • Thorough psychosocial evaluation is critical before proceeding with this extensive procedure.
5. Metastatic or Recurrent Disease (First-Line Therapy)
   • A platinum-based regimen (cisplatin or carboplatin) combined with paclitaxel, with or without bevacizumab, remains a standard option.
   • For PD-L1–positive tumors, adding pembrolizumab has shown a survival advantage.
   • Bispecific immunotherapy and novel therapeutic regimens are under investigation to improve outcomes further.
6. Second-Line Therapy
   • Tissue factor–directed antibody–drug conjugates (e.g., tisotumab vedotin) are effective for patients whose disease progresses after frontline therapy.
   • HER2-targeted therapies (e.g., trastuzumab deruxtecan) may benefit individuals with HER2-overexpressing cervical tumors.
   • Immune checkpoint inhibitors (cemiplimab, nivolumab) can be used in PD-L1–positive recurrent disease, although prior treatment with pembrolizumab may affect efficacy.

Conclusion: By combining targeted vaccination, robust screening programs, and multidisciplinary treatment strategies, cervical cancer can be dramatically reduced worldwide. Advanced management incorporates state-of-the-art surgical procedures, chemoradiation, immunotherapies, and emerging targeted therapies to extend survival and enhance quality of life. Ongoing research aims to optimize treatment sequencing, define new biomarkers, and advance global eradication efforts.

Reference:
Tewari KS. Cervical Cancer. New England Journal of Medicine. (2025). Link: https://www.nejm.org/doi/full/10.1056/NEJMra2404457