Loading
10 slides generated from the cancer page, with a quiz from the open benchmark and speaker notes that cite the sources. Arrow keys move between slides; Print gives one slide per page.
A cancer that could be eliminated by HPV vaccination and screening. For those who develop it, immunotherapy and a tissue-factor ADC have improved survival.
Cervical cancer is almost entirely caused by persistent infection with high-risk human papillomavirus, which makes it the one common cancer that could be eliminated: HPV vaccination prevents about 90% of cases, HPV screening finds the precancers that remain, and a minute of thermal ablation or a loop excision cures them. Around 660,000 women are diagnosed and 350,000 die each year, nine in ten of them in low- and middle-income countries where vaccination and screening have not reached. In Sweden, Scotland, and Australia, cohorts vaccinated at 12-13 show near-zero invasive cancer, and Australia expects to pass the WHO elimination threshold (4 per 100,000) around 2035.
For women who develop cancer, treatment depends on stage. Early disease is treated with open radical hysterectomy (minimally invasive surgery proved worse in the LACC trial) or, for the smallest tumours, fertility-sparing surgery, with sentinel node mapping under evaluation. Locally advanced disease is cured in roughly two-thirds by cisplatin chemoradiation with brachytherapy, and two 2023-24 trials improved on that standard for the first time since 1999: six weeks of induction carboplatin-paclitaxel (INTERLACE, 5-year OS 80% vs 72%) and pembrolizumab with chemoradiation (KEYNOTE-A18, 36-month OS 82.6% vs 74.8%). Metastatic or recurrent disease, once treated with chemotherapy alone, now has first-line chemotherapy plus a checkpoint inhibitor with or without bevacizumab (KEYNOTE-826, BEATcc, COMPASSION-16 in China), the tissue-factor ADC tisotumab vedotin in second line (innovaTV 301), and HER2-directed therapy for the minority with HER2-positive tumours.
| Setting | Approach | Guideline |
|---|---|---|
| Prevention | HPV vaccination age 9-14; HPV primary screening. | not mapped |
| Locally advanced | Cisplatin chemoradiation + brachytherapy + pembrolizumab. | not mapped |
| Recurrent/metastatic | Pembrolizumab-chemotherapy-bevacizumab; tisotumab vedotin. | ESMO-MCBS 2 (innovaTV 204 tisotumab vedotin, single-arm) |
| Primary prevention | HPV vaccination of girls (and boys) at 9-14, one or two doses per WHO; catch-up to 26 (US label to 45). Reduces invasive cancer ~90% when given before exposure. | NCCN Prevention guideline |
| Screening | HPV primary testing every 5 years from 25-30 (self-sampling accepted), or cytology every 3 years; VIA or HPV screen-and-treat in low-resource settings; WHO target 70% screened twice in a lifetime. | NCCN USPSTF Grade A |
| Precancer (HSIL / CIN2-3, AIS) | Colposcopy-directed biopsy then LEEP/LLETZ or cone excision; thermal ablation or cryotherapy where eligible; HPV test of cure at 6-12 months. | NCCN ASCCP 2019 risk-based management |
| Stage IA1-IB1 (≤2 cm) | Simple hysterectomy is non-inferior to radical for low-risk IA2-IB1 ≤2 cm (SHAPE trial, 2024); cone or trachelectomy for fertility preservation; sentinel node mapping in trials (SENTICOL III). | NCCN 2A |
| Stage IB2-IIA (surgical candidates) | Open radical hysterectomy with pelvic lymphadenectomy (minimally invasive approach inferior in LACC); adjuvant radiation or chemoradiation for intermediate/high-risk pathology (Sedlis, Peters criteria). | NCCN 1 (open approach) |