Complications

• Local infiltration of organs

  • Infiltration and compression of ureter → urinary obstruction → hydronephrosis → kidney failure (bilateral obstruction is a potentially fatal complication)

  • Other organs often affected by the spread of cervical cancer include the rectum, bladder, and vagina.

• Fistula formation in locally advanced disease (e.g., rectovaginal, vesicovaginal, urethrovaginal fistula)

• Compression of veins or lymphatic vessels in the lesser pelvis → lymphedema of the lower extremities

• Metastasis [45]

  • Bone metastasis: bone pain, pathologic fractures, spinal compression, hypercalcemia

  • Liver metastasis: abdominal pain, abdominal distention, nausea, jaundice

  • Lung metastasis: cough, hemoptysis, dyspnea, chest pain

  • Brain metastasis: headaches, seizures, cognitive deficits, focal neurological deficits

• Cancer anorexia-cachexia syndrome (CACS)

• Vaginal stenosis

• Postirradiation vaginitis (e.g., vaginal dryness, dyspareunia)

• Radiogenic cystitis/proctitis

• Radiation may increase the risk of cancer complications such as fistula formation

• Cervical cancer has the best prognosis out of the three main gynecological cancers (ovarian, endometrial, and cervical cancer).

• The survival rates decrease with increasing FIGO stage [49]

  • Stage 0: > 93%

  • Stage I: 93%

  • Stage II: 63%

  • Stage III: 35%

  • Stage IV: 16%

• Patients without lymph node involvement have a very good prognosis, regardless of FIGO stage.

• Main cause of death: uremia, often occurs secondary to bilateral ureteral obstruction.

Principal measures: HPV immunization, preferably before first sexual intercourse, and barrier protection (condoms) during sexual intercourse.

• Current vaccination guidelines

  • Administration of 2 doses of nine-valent HPV vaccine to all individuals (male and female) between 11–12 years of age

    • Immunization can be started as early as 9 years of age.

    • The 2nd dose should be administered 6–12 months after the 1st dose.

  • Administration of 3 doses of nine-valent HPV vaccine to all unvaccinated individuals between 15–26 years of age

    • The 2nd dose should be given 1–2 months after the 1st dose and the 3rd dose 6 months after the first dose.

    • Also preferred regimen for vaccination of immunocompromised individuals (e.g., HIV) [53]

• FDA-approved vaccines [54]

  • Bivalent vaccine: protection against high-risk HPV types 16 and 18

  • Tetravalent vaccine: protection against low-risk types 6 and 11 (most common cause of genital warts) as well as high-risk HPV types 16 and 18

  • Nine-valent vaccine: protection against low-risk types 6 and 11 as well as high-risk HPV types 16, 18, 31, 33, 45, 52, and 58

  • The FDA, ACOG, and ASCCP have approved a supplemental application of the nine-valent vaccine for all individuals between 27–45 years of age.