36. 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, but a subset remains infected. This kind of infection can lead to premalignancies, which can be picked up by the national screening programme with PAP smears. Women with abnormal PAP smears are referred to a gynaecologist for a colposcopy by their general practitioner. If 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) or regress with imiquimod immunomodulating cream. If a high-grade lesion remains undetected or is left untreated, cervical cancer may develop. Nowadays, vaccination against hr-HPV can 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 based on physical examination and imaging. In the Netherlands, an MRI scan of the pelvis is recommended in suspected early-stage disease. In case of suspected higher stage disease, an additional PET-CT scan is warranted. Surgery is the cornerstone of curative treatment in localised disease. With locally advanced disease, chemoradiation therapy with curative intent is the cornerstone of treatment. Prognosis for early-stage disease is very good.