Surveillance procedures for patients with cervical carcinoma a review of the literature

Cervical cancer is still one of the most common malignancies in women. Treatment of cervical cancer is very successful, especially in the early stage. However, some patients will experience recurrence. The primary purpose of follow-up programs is early detection of recurrence disease that should be more likely to be amenable to treatment, thereby improving the clinical outcome. Although, in the literature, most studies have shown that the surveillance programs did not improve the clinical outcome of patients with diagnosis of recurrence, this clinical practice is regarded as traditional management. The use of Papanicolaou tests to detect recurrent cervical cancer is not sufficiently justified. The assessment of tumor markers such as the squamous cell carcinoma antigen could be useful. Imaging techniques are important for the detection and assessment of recurrent disease. The role of chest x-rays in detecting asymptomatic recurrence in patients treated for cervical carcinoma remains controversial. Detection of a new abnormal mass or the changes in the size of a known lesion caused by cancer growth and the determination of the extent of recurrence with computed tomography and magnetic resonance imaging may provide clinical assistance in the selection of optimal therapy. The fluoro-2-deoxy-glucose-positron emission tomography for surveillance only show 80% of specificity and accuracy with negative predictive value of 100%. Integrated fluoro-2-deoxy-glucose-positron emission tomography/computed tomography provides precise anatomic localization of suspicious areas and, therefore, a better diagnostic interpretation with a possible impact on disease-free survival as well. In conclusion, our review confirms the need for prospective studies to compare the effectiveness of different follow-up regimens measuring overall survival and quality of life parameters as outcomes. Copyright © 2009 by IGCS and ESGO.