University of Kansas School of Medicine-Wichita, Wichita, KS, USA.
Am Fam Physician. 2018 Apr 1;97(7):449-454.
Human papillomavirus infection is the precursor for the development of cervical cancer and is detectable in 99.7% of squamous cell carcinoma and adenocarcinoma cases. Early detection of precancerous lesions with Papanicolaou testing remains the primary mechanism for cancer prevention. Once cervical cancer is diagnosed, treatment may involve surgery, radiation therapy, chemotherapy, or a combination. The choice of therapy depends on the stage of disease, lymph node involvement, patient comorbidities, and risk factors for recurrence. Early-stage, microinvasive disease may be treated with surgery alone if margins are negative and there is no lymph node involvement; adjuvant chemoradiation should be considered for other early-stage disease. Locally advanced disease is often treated with chemoradiation. The addition of bevacizumab, an antivascular endothelial growth factor monoclonal antibody, to combination chemotherapy improves survival among patients with recurrent, persistent, or metastatic cervical cancer. Disease stage and lymph node involvement are the most prognostic factors. Pregnancy status and desire to preserve fertility should be considered when developing a treatment strategy. After treatment, close follow-up with a gynecologist-oncologist for pelvic examinations at regular intervals is recommended to assess for recurrence.
人乳头瘤病毒感染是宫颈癌发展的前兆，可在 99.7%的鳞状细胞癌和腺癌病例中检测到。巴氏试验早期检测癌前病变仍然是癌症预防的主要机制。一旦诊断出宫颈癌，治疗可能涉及手术、放疗、化疗或联合治疗。治疗方案的选择取决于疾病的阶段、淋巴结受累情况、患者合并症以及复发的危险因素。如果边缘阴性且无淋巴结受累，早期、微浸润性疾病可能仅通过手术治疗；对于其他早期疾病，应考虑辅助放化疗。局部晚期疾病通常采用放化疗。贝伐单抗（一种抗血管内皮生长因子单克隆抗体）联合化疗可改善复发性、持续性或转移性宫颈癌患者的生存率。疾病分期和淋巴结受累是最重要的预后因素。制定治疗策略时应考虑妊娠状况和保留生育能力的愿望。治疗后，建议定期与妇科肿瘤学家进行密切随访，进行盆腔检查以评估复发情况。
