PET Scans Recommended For All Patients With Advanced Cervical Cancer

April 2017

Cancer

Country of origin: UK

A guideline for the care and management of patients with cervical cancer recommends a PET-CT scan for all women with advanced and/or recurring cervical cancer. The guideline also emphasises that treating the disease does not have to mean that women will be unable to conceive at a later date.

The guideline from the Scottish Intercollegiate Guidelines Network (SIGN) - entitled ?Management of cervical cancer? - presents a challenge for those charged with organising cancer services to ensure that appropriate access to imaging is available to all. It is estimated that around 150 women a year will require a PET/CT scan to improve their treatment planning, which may result in improved survival and quality of life. PET imaging has been identified as cost-effective as it can avoid inadequate or inappropriate treatment options.

The guideline will give encouragement and hope to many patients who may have assumed that surgical treatment for cervical cancer would mean a hysterectomy that would end their chances of conceiving a child.

Surgical options that retain a woman?s ability to become pregnant, such as radical trachelectomy, cold knife conisation and large loop excision of the transformation zone, are an important component of the SIGN guideline for women with operable cervical cancer. Although the newer surgical procedures have not been tested in randomised trials, data is available from large series carried out at well known institutions.

The guideline aims to ensure that equitable standards of care are available to all women who develop cervical cancer and the social and economic burden it places on women and their carers is minimised. SIGN recommendations are based on systematic reviews of best available evidence.

The SIGN guideline covers the following areas:

? the importance of multidisciplinary working and the role of the clinical nurse specialist
? the importance of signs and symptoms and referral to specialist centres
? histopathological, clinical, and radiological staging
? surgical and non-surgical treatment of cervical cancer including fertility conserving treatment and treatment during pregnancy
? complications of cervical cancer and its treatment including sexual morbidity, lymphoedema and bladder and bowel morbidity
? follow up and detection and management of recurrent disease
? management of complications in advanced disease including renal failure, haemorrhage, thrombosis and malodour
? psychosocial care and support for patients and carers including sources of further information.

Commenting on the guidance, Dr Nadeem Siddiqui, Chair of the SIGN Cervical Cancer Group, said: ?Cervical cancer is a potentially curable disease, although the therapy is intensive. This new guideline will give hope and confidence to many women suffering from this disease that they can recover and go on to live normal and fulfilling lives.

?The need for guidance on the management of cervical cancer was highlighted by variation in practice over different aspects of disease management. When this guideline was proposed not all regions in Scotland had adopted chemotherapy and were still treating women with radiotherapy alone. Not all women were having MRI to assess tumour volume during pre-surgical staging and palliative care services were neither standardised nor available to the same extent in all regions.

?In working on this guideline we have looked at the full range of evidence and research from the widest possible variety of sources. The result is a clear set of clinical guidelines for the assessment and treatment of cervical cancer that will produce a high standard of consistent care across Scotland.?

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