Complications
The most common adverse effects of programmed cell death protein-1 (PD-1) or programmed cell death ligand-1 (PD-L1) inhibitor therapies are: anaemia (45.4%), fatigue (34.3%), dysphagia (30.0%), neutropenia (19.6%), lymphopenia (10.2%), hypertension (9.3%), and elevated lipase (7.2%).[249] Other potential adverse effects include colitis, myocarditis, pericarditis, and skin toxicities.[250]
Before starting treatment, counsel patients and carer on the symptoms of immune-related adverse effects.[197]
Patients receiving immunotherapy should be monitored closely for treatment-related toxicity and endocrine dysfunction. Guidelines for monitoring of patients and management of complications are available.[195][196][197][251]
Should be treated with vaginal packing, with or without the use of topical Monsels, adrenaline (epinephrine), acetone, or aminocaproic acid. Radical hysterectomy can be performed if necessary and if the lesion is amenable. A short course of radiotherapy can be effective as well, and should be integrated into the overall treatment plan if fertility preservation is not desired. Use of arterial embolisation is less acceptable.
A surgical complication that is often a complex of both instability and denervation. Nerve-sparing surgery (type C1 hysterectomy) may reduce risk of this complication.[138]
Limited evidence suggests that bethanechol may minimise the risk of bladder dysfunction by lowering post‐void residual urine volume. The effectiveness of different types of postoperative urinary catheterisation (suprapubic and intermittent self‐catheterisation) remains unproven.[241] Further research is needed for these and other potential treatments (e.g., cisapride, bladder training, and acupuncture).
Late consequences of radiotherapy. Women who receive a higher radiation dose or who have tumour extension into the vagina are at higher risk.[245] Maintenance of vaginal patency with vaginal dilators during and after radiotherapy is important not only to preserve sexual function, but also to permit adequate follow-up pelvic examinations.[246]
Reported prevalence varies considerably.[242][243][244] Patient education and counselling (preferably involving both partners) are very important components of managing sexual dysfunction. Pharmacological approaches include topical oestrogens and transcutaneous testosterone. Referral to a physiotherapist with expertise in pelvic floor-related conditions may also be of benefit.
Late consequence of radiotherapy.[246] Early referral to a lymphoedema clinic is encouraged.
Later consequence of radiotherapy, affecting 3.4% of women after 5 years.[247]
A surgical complication that may cause considerable disability.
Local excision and ablation treatments for pre-invasive and early invasive cancer increase the risk of preterm birth in subsequent pregnancy.[129]
Most standard treatments for cervical cancer, such as hysterectomy and radiotherapy, lead to early menopause and permanent infertility. Discuss reproductive wishes, the risks of ovarian dysfunction and infertility, and options for fertility preservation before beginning treatment for patients of reproductive age.[130][131]
Fertility-sparing treatment, such as cone biopsy and simple or radical trachelectomy, may be an option for select women with early-stage cervical cancer. Systematic reviews suggest that oncological outcomes are similar for different fertility-sparing techniques, but that vaginal radical trachelectomy may achieve improved reproductive outcomes compared with abdominal or laparoscopic approaches.[155][156][157][158]
Fertility-preserving strategies may include oocyte, embryo, or ovarian tissue cryopreservation.[131] Ovarian transposition (oophoropexy) can be offered to premenopausal women having radiotherapy to maintain ovarian function and prevent premature ovarian failure.[131]
Late consequences of radiotherapy. Risk approximately 3% after 5 years.[248]
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