, Violante Di Donato 1, Andrea Giannini 2,*
1 Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, 00161 Rome, Italy
2 Department of Medical Surgical Sciences and Translational Medicine, Sapienza University, 00189 Rome, Italy
Cervical cancer has a high incidence and mortality in developing countries due to the lack of structured screening programs. Human papillomavirus (HPV) infection and its persistence represent the primary risk factors for cervical cancer, while, the concurrent infection with human immunodeficiency virus (HIV) elevates the risk of developing cervical cancer by a factor of six [1].
Prophylactic vaccination, and more recently adjuvant vaccination, significantly
reduce the risk of cervical cancer but do not eliminate it [2]. Screening
consists of performing Papanicolau tests (pap test) or HPV tests, followed by
colposcopy with targeted biopsy in case of positive results. Early diagnosis is
critical, as the stage at diagnosis is one of the primary prognostic factors.
Early-stage cervical cancers according to the International Federation of
Gynecology and Obstetrics (FIGO) 2018 classification include stages IA1-IB2 and
IIA1 [3]. In this case, premenopausal patients and those who desire to maintain
fertility, after careful consultation and tumor histopathological evaluation
(tumors
Lymph node assessment is a critical procedure in determining treatment, as lymph node metastasis is prognostic factor that necessitates adjuvant therapies. Historically, systematic pelvic lymphadenectomy was the standard method for evaluating lymph node status. However, in recent years, sentinel lymph node biopsy has gained popularity due to its lower incidence of side effects and post-operative complications [10, 11, 12, 13].
Patients not eligible for conservative treatment were previously submitted to
radical surgery, with the removal of the uterus, cervix, parametrium, upper third
of the vagina and pelvic lymph node staging (systematic lymphadenectomy and/or
sentinel lymph node biopsy) with or without bilateral salpingo-oophorectomy.
Guidelines for the treatment of early-stage cervical cancer, however, are
constantly evolving, secondary to advances in cancer research [3, 14]. Recently,
the publication of the SHAPE (Simple Hysterectomy and Pelvic Node Assessment)
trial has revolutionized this approach, demonstrating that simple hysterectomy in
patients with low-risk cervical cancer (lesions
Future research is likely to focus on identifying new prognostic and predictive biomarkers to further personalize treatment and minimize patient exposure to unnecessary or overly aggressive therapies. Additionally, the development of targeted therapies, immunotherapies, and second-generation HPV vaccines may further improve outcomes for patients with cervical cancer.
In conclusion, the management of early-stage cervical cancer has advanced significantly over recent decades, driven by improvements in early diagnosis, surgical techniques, and adjuvant therapies.
However, ensuring equitable access to timely and high-quality care for all patients, regardless of their place of residence or socio-economic status, remains a significant challenge. The future of cervical cancer management will require a more personalized approach, with treatments increasingly tailored to the molecular and genetic profiles of the tumor. This will further enhance patient survival and improve quality of life.
VDD designed the study. TGD performed the research. AG analyzed the data. TGD and AG wrote the manuscript. All authors contributed to editorial changes in the manuscript. All authors read and approved the final manuscript. All authors have participated sufficiently in the work and agreed to be accountable for all aspects of the work.
Not applicable.
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This research received no external funding.
The authors declare no conflict of interest. Andrea Giannini and Violante Di Donato are serving as Guest editors of this journal. Andrea Giannini is also serving as one of the Editorial Board members of this journal. We declare that Andrea Giannini and Violante Di Donato had no involvement in the peer review of this article and has no access to information regarding its peer review. Full responsibility for the editorial process for this article was delegated to Michael H. Dahan and Yasuhiko Ebina.
References
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