25. Cervical premalignancies and cervical cancer

Cervical premalignancies are caused by an asymptomatic infection with high-risk human papilloma virus (hr-HPV). Most women clear these infections; however, a subset remains infected. Such an infection can lead to premalignancies, which can be picked up by the national screening program with PAP smears. Women with abnormal PAP smears are referred, by their general practitioner, to the gynaecologist for a colposcopy. When abnormalities are detected, biopsies are taken to histologically confirm the suspicion. High-grade lesions are treated by removing the abnormal area by a loop electrosurgical excision procedure (LEEP). If a high-grade lesion remains undetected or is left untreated, cervical cancer may develop. Nowadays, vaccination against hr-HPV may prevent this type of tumour. In case of diagnosis of cervical cancer a systematic, multidisciplinary workup is needed. The FIGO stage of disease needs to be established and is purely based on physical examination. In the Netherlands an MRI scan of the small pelvis is recommended in suspected early stage disease. In case of suspected higher stage disease a PET-CT scan is warranted. Surgery is the cornerstone of curative treatment in localized disease. With locally advanced disease, chemoradiation therapy with curative intent is the cornerstone of treatment. Prognosis for early stage disease is very good.