Ovarian preservation should be discussed with women in reproductive age with squamous cell carcinoma, can be considered in HPV-associated adenocarcinoma and is not recommended for HPV-independent adenocarcinomas. Opportunistic bilateral salpingectomy should be performed if ovaries are preserved. Ovarian transposition should be discussed upfront with the patient and individualized according to risk balance [IV, A]. Patients with recurrent/metastatic disease should have a full clinical-diagnostic evaluation to assess the extent of disease and the most appropriate treatment modality including best supportive care [V, A].

Management of patients with T1a1 disease should be tailored to the individual depending on age, desire for fertility preservation, histological type, and the presence or absence of LVSI [III, B]. The expertly crafted formula enables optimised breakdown and detoxification of estrogen. This gives your body the best chance to lose stubborn lower body fat, regulate hormonal balance and potentially help with the appearance of cellulite. Ingredients ESTRO SUPPORT BLEND: Uncover the potential well-being benefits of Estro Support, a proprietary blend of 100% natural alkaline herbs crafted with women's wellness in mind. Before starting each cycle of chemotherapy, an assessment of treatment response should be made by clinical examination and transvaginal or transrectal ultrasound. If no response is achieved after 2 cycles of chemotherapy during pregnancy, treatment strategy should be re-evaluated. For surgery, avoidance of the combination of radical surgery and post-operative external radiotherapy requires acceptance for modifications of the traditional selection criteria (tumor size, degree of invasion, LVSI) for adjuvant treatment [IV, B].Specimens from prior conization and subsequent conization, trachelectomy, or hysterectomy should be correlated for estimation of the tumor size. This is important since different specimens may have been reported at different institutions. It should also be recognized that simply adding the maximum tumor size in separate specimens may significantly overestimate the maximum tumor dimension. Histological tumor type according to the most recent WHO classification (currently 5th edition, 2020, in its updated version). Additional supplemental ma PALND (at least up to inferior mesenteric artery) may be used to assess the need for elective para-aortic EBRT in patients with negative para-aortic lymph nodes (PALN) and positive PLN on imaging [IV, C]. Cervical cancer is a major public health problem, ranking as the fourth most common cause of cancer incidence and mortality in women worldwide. There are geographical variations in cervical cancer that reflect differences particularly in the prevalence of human papillomavirus (HPV) infection and inequalities in access to adequate screening and treatment [ 1]. Cervical cancer is uncommon in Europe but still remains the most frequent cause of cancer death in middle-aged women in Eastern Europe [ 2]. Other epidemiologic risk factors associated with cervical cancer are notably a history of smoking, oral contraceptive use, early age of onset of coitus, number of sexual partners, history of sexually transmitted disease, certain autoimmune diseases, and chronic immunosuppression. Squamous cell carcinomas account for approximately 80% of all cervical cancers and adenocarcinoma accounts for approximately 20%. The WHO recently launched a global initiative to scale up preventive, screening, and treatment interventions relying on vaccination against HPVs, screening and treatment of detected cervical pre-invasive and invasive lesions, and offering the best possible curative care to women diagnosed with invasive cancer [ 3].

Cibula D, Pötter R, Planchamp F et al (2018) The European Society of Gynaecological Oncology/European Society for Radiotherapy and Oncology/European Society of Pathology Guidelines for the management of patients with cervical cancer. Int J Gynecol Cancer 28:641–55 Balázs Madas (HU), Brita Singers Sørensen (DK), Kasper Rouschop (NL), Kerstin Borgmann (DE), Laure Marignol (IE), Martin Pruschy (CH), Navita Somaiah (UK), Nicolas Foray (FR), Paul Span (NL), Randi Syljuåsen (NO), Ross Carruthers (UK)

Footnotes

The guidelines detailed in this article cover staging, management, follow-up, long-term survivorship, quality of life and palliative care. Management includes fertility sparing treatment, early and locally advanced cervical cancer, invasive cervical cancer diagnosed on a simple hysterectomy (SH) specimen, cervical cancer in pregnancy, rare tumors, recurrent and metastatic diseases. A summary of evidence supporting the guidelines is included in Online Supplemental File 1, available online. General Recommendations Treatment of patients with cervical cancer in pregnancy should be exclusively done in gynecological oncology centers associated with the highest level perinatal center with expertise in all aspects of oncologic therapy in pregnancy and intensive medical care of premature neonates [V, A]. Para-aortic LN dissection (PALND), at least up to inferior mesenteric artery, may be considered in locally advanced cervical cancer with negative para-aortic LN on imaging for staging purposes [IV, C].

Definitive management (ie, without tumor related surgery) consists of EBRT with concomitant platinum-based chemotherapy and BT. Delay of treatment and/or treatment interruptions have to be prevented to avoid tumor progression and accelerated repopulation. The overall treatment time including both EBRT and BT should therefore not exceed 7 weeks. Definitive CTRT and BT CTRT Quality of life and side effects should be regularly assessed at least by the physicians/clinical care nurses and if possible by patients (using patient related outcomes). Patient self-reporting of side effects should be encouraged during and after treatment with the same frequency as medical visits [IV, B].

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In case of intraoperatively proven PLN involvement, fertility-sparing surgery should be abandoned and patients should be referred for CTRT and BT [IV, B]. PALND, at least up to inferior mesenteric artery, may be considered for staging purposes [IV, C]. Ovarian transposition cannot be recommended in N1 status [IV, D]. Patients should be carefully counseled on the suggested treatment plan and potential alternatives, including risks and benefits of all options [V, A]. Please enjoy adding Quantum Estro Support to your daily nutritional regimen and feel the difference. Go Quantum!