The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

General Information

Updated statistics with estimated new cases and deaths for 2009 (cited American Cancer Society as reference 1).

Added text to include HPV testing as a diagnostic test used to detect cervical cancer. Also added that in surgically treated patients clinical stage as a prognostic factor must include several gross and microscopic pathologic findings.

Added text about the indication from Gynecologic Oncology Group studies that prognostic factors vary whether clinical or surgical staging are used, and with treatment; added an association between delayed radiation delivery completion and poorer progression-free survival with the use of clinical staging; mentioned other prognostic factors that studies showed may or may not hold up when utilizing chemoradiation (cited Monk et al. as reference 8).

Added text about the presence of human papillomavirus (HPV) 18 DNA type as the most-established molecular factor associated with outcome and mentioned two studies in which HPV18 DNA type is an independent prognostic factor in patients with cervical carcinomas treated with radical hysterectomy and pelvic lymphadenectomy (cited Burger et al. as reference 16 and Lai et al. as reference 17).

Added text about the usefulness of HPV DNA testing in triaging patients with atypical squamous cells of undetermined significance to colposcopy, a practice which has been integrated into current screening guidelines (cited Wright et al. [Am J Obstet Gynecol, 346-55] as reference 21 and Wright et al. [Am J Obstet Gynecol, 340-45] as reference 22).

Stage Information for Cervical Cancer

Added Gold et al. as reference 1.

Treatment Option Overview

Added text to list standard treatments for patients with cervical cancer, which include surgery, radiation therapy and chemotherapy.

Added Chemoradiotherapy for Cervical Cancer Meta-Analysis Collaboration Group as reference 9.

Added text to list treatments under clinical evaluation, which include new anticancer drugs in phase I and phase II clinical trials.

Added text to include Cervical cancer during pregnancy as a new subheading.

Added Hunter et al. as reference 15.

Stage 0 Cervical Cancer

Added text about the issuance of consensus guidelines for managing women with cervical intraepithelial neoplasia or adenocarcinoma in situ (cited Wright et al. as reference 1).

Added text to include total abdominal or vaginal hysterectomy for postreproductive patients and internal radiation therapy for medically inoperable patients to the list of methods to treat ectocervical lesions.

Stage IB Cervical Cancer

Added text to include the Federation Internationale de Gynecologie et d'Obstetrique stages IA2 and IB1 for women with small-volume disease.

Added text to include concomitant chemotherapy and radiation therapy for adenocarcinomas that expand the cervix more than 4 cm.

Added text to include concomitant chemotherapy with already stated pelvic and para-aortic radiation therapy; also added chemotherapy as a postoperative therapy with radiation therapy; added chemotherapy as a treatment with extended-field radiation therapy.

Cited Chemoradiotherapy for Cervical Cancer Meta-Analysis Collaboration Group as reference 19

Added text about the use of radiosensitizing chemotherapy being indicated for stage IB2 lesions, but stated that the role of radiosensitizing chemotherapy in IA2 and IB1 lesions is untested and most likely of marginal benefit.

Added Monk et al. as reference 25.

Stage IIA Cervical Cancer

Cited Chemoradiotherapy for Cervical Cancer Meta-Analysis Collaboration Group as reference 17.

Cited Monk et al. as reference 20.

Added text about the use of radical surgery for small lesions versus concomitant chemotherapy and radiation.

Stage IIB Cervical Cancer

Cited Chemoradiotherapy for Cervical Cancer Meta-Analysis Collaboration Group as reference 15

Cited Monk et al. as reference 18.

Stage III Cervical Cancer

Cited Chemoradiotherapy for Cervical Cancer Meta-Analysis Collaboration Group as reference 13.

Cited Monk et al. as reference 16.

Stage IVA Cervical Cancer

Cited Chemoradiotherapy for Cervical Cancer Meta-Analysis Collaboration Group as reference 8.

Cited Monk et al. as reference 11.

Stage IVB Cervical Cancer

Added text to include cisplatin/topotecan as a standard treatment option (cited Long et al. as reference 12).

Added text to include new anticancer drugs in phase I and phase II clinical trials as treatment options under clinical evaluation.

Recurrent Cervical Cancer

Added text about the seven Gynecologic Oncology Group (GOG) randomized phase III trials that showed only one regimen being superior in overall survival to single-agent cisplatin (cited Tewari et al. as reference 3 and Long et al. as reference 4). Also stated that the cisplatin/topotecan doublet shows more bone marrow suppression compared to cisplatin alone, but there was no associated decrement in quality of life found with the combination (cited Monk et al. [J Clin Oncol 2005] as reference 5).

Added text about patients with performance status of 0 or 1 who tolerated the combination in the GOG-selected paclitaxil plus cisplatin regimen because it was superior to cisplatin alone in response rates and progression-free survival (cited Monk et al. [J Clin Oncol 2008] as reference 6).

Added text to include as standard treatment options the following drugs: bevacizumab (cited Monk et al. [J Clin Oncol 2009] as reference 13); ifosfamide/cisplatin; cisplatin/topotecan; and cisplatin/vinorelbine (cited Morris et al. as reference 18).

Added text to include new anticancer drugs in phase I and phase II clinical trials as treatment options under clinical evaluation.

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