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OG33.1-2 | Cervical Cancer — SDL Guide (Part 3)

Prognosis, Follow-up, and Complications of Treatment

Prognosis in cervical cancer is primarily determined by FIGO stage at diagnosis, with 5-year survival rates declining steeply from early to advanced stages: Stage IA — approximately 95–98%; Stage IB — 80–90%; Stage IIA — 70–75%; Stage IIB — 65–70%; Stage IIIA/IIIB — 40–50%; Stage IVA — 20–25%; Stage IVB — <15%. Lymph node involvement is the single most powerful independent prognostic factor after stage — women with positive pelvic nodes have a 5-year survival approximately 40–50% lower than node-negative patients at the same clinical stage. Other adverse prognostic factors include large tumour volume, poorly differentiated histology, and lymphovascular space invasion.

Post-treatment surveillance follows a structured schedule to detect recurrence early — approximately 70% of recurrences occur within the first two years. The standard follow-up is: 3-monthly visits for the first 2 years (clinical examination, vault smear), then 6-monthly visits for years 3–5, and annually thereafter. At each visit, the clinician examines the vaginal vault for local recurrence, the inguinal and supraclavicular nodes for distant nodal disease, and evaluates any new symptoms. Imaging (CT or PET-CT) is reserved for symptomatic women or those with rising SCC antigen.

Complications of Wertheim's radical hysterectomy include: (a) ureteric injury or uretero-vaginal fistula — the ureter's proximity to the cardinal ligament makes it vulnerable; (b) bladder dysfunction (neurogenic atony, from sacrifice of parasympathetic pelvic plexus) requiring prolonged catheterisation; (c) lymphocyst formation and lymphoedema from pelvic lymphadenectomy; (d) vault haematoma; (e) early ovarian failure if ovaries removed in premenopausal women. Complications of chemoradiation include early effects (radiation cystitis, proctitis, diarrhoea, myelosuppression from cisplatin, nausea) and late effects (radiation fibrosis of the small bowel causing obstruction/malabsorption, vesico-vaginal or recto-vaginal fistulae, vaginal stenosis, ureteric stricture, secondary malignancies). The risk of radiation fistulae is higher when surgery precedes radiation (combined modality treatment), which is why primary chemoradiation is preferred over surgery-then-radiation in locally advanced disease.

5-Year Survival Rates by FIGO 2018 Stage in Cervical Cancer

Self-Assessment and Case Integration

This section consolidates the key factual and clinical reasoning skills from the module. Before attempting the self-check questions below, review the FIGO 2018 staging table and the stage-directed management algorithm. Common examination pitfalls include: (a) confusing Stage IIB (parametrial involvement not reaching pelvic wall) with Stage IIIB (pelvic wall involvement); (b) forgetting the IIIC sub-stages and the r/p notation; (c) describing the wrong histological type as most common; (d) misidentifying the correct management for Stage IB2 (chemoradiation or radical hysterectomy — both are acceptable, but primary surgery with expected adjuvant radiation is avoided in many centres); (e) confusing complications of surgery versus radiation. Practise by assigning stages to clinical vignettes before looking up the answer — the staging exercise is exactly how examination questions are constructed.

Cervical Cancer FIGO 2018 Staging — Extent of Spread