New approaches for the management of cervical cancer.

Since the introduction of the Pap test by George Papanicolaou, the incidence of cervical cancer has fallen and mortality has decreased, in parallel with effective treatment of the precancerous and in situ stages of the disease. However, women who are not diagnosed through screening usually present with advanced disease. Early invasive disease can be treated successfully with radical abdominal hysterectomy and pelvic lymphadenectomy or with radiotherapy. A surgical alternative is radical trachelectomy, which can preserve fertility in young women. Advances in the techniques of laparoscopy facilitate procedures, such as radical vaginal hysterectomy with laparoscopic lymphadenectomy, that decrease intra-abdominal scarring and length of hospital stays. The presence of lymph node metastases alters the type of therapy. A range of methods is available to assess lymph nodes, including positron emission tomography, a new approach that may be of value. Radiotherapy alone may not be successful in women with locally advanced disease and adding chemotherapy may eradicate systemic micrometastases that are not affected by radiation. Single-agent cisplatin is the current agent of choice for adding to radiotherapy but new agents are being evaluated. Persistent infection with human papillomavirus (HPV) is associated with the development of cervical cancer. Vaccines against HPV are being developed and clinically tested and hopefully in the future it may be possible to eradicate cervical cancer.