Cervical cancer: the decisions you may face

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

1. Is HPV & HBV vaccination the only reasonable path for me, or is there a trial, a different sequence or a wait-and-see option?
   Why: A single standard does not mean a single choice; timing and trials are decisions too.
2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
   Why: The aim shapes how much side effect and disruption is worth accepting.
3. What happens if I delay, or decline this step for now? Is the decision reversible?
   Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
4. Does your recommendation follow the current guideline (NCCN Guidelines: Cervical Cancer), and if it departs from it, why?
   Why: Departures from guidelines are sometimes right for an individual; they should be explained.
5. For my situation (prevention), which of the standard options do you recommend and why?
   Why: Guideline options include: HPV vaccination age 9-14; HPV primary screening.

Add these to your appointment list, or take the full question set for this cancer.

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

1. Between Brachytherapy, IMRT / IGRT (modern external beam) and Pembrolizumab, which do you recommend for me, and what about my case would make you choose differently?
   Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
   Why: The aim shapes how much side effect and disruption is worth accepting.
3. Which side effects of Pembrolizumab are most likely for me, which are reversible, and which would make us stop?
   Why: The recorded rates below come from labels and trials; your own risk depends on dose, other medicines and your health.
4. What happens if I delay, or decline this step for now? Is the decision reversible?
   Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
5. Does your recommendation follow the current guideline (NCCN Guidelines: Cervical Cancer), and if it departs from it, why?
   Why: Departures from guidelines are sometimes right for an individual; they should be explained.
6. For my situation (locally advanced), which of the standard options do you recommend and why?
   Why: Guideline options include: Cisplatin chemoradiation + brachytherapy + pembrolizumab.
7. Am I a candidate for Pembrolizumab, and what side effects should I expect?
   Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Add these to your appointment list, or take the full question set for this cancer.

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

1. Between Pembrolizumab and Tisotumab vedotin, which do you recommend for me, and what about my case would make you choose differently?
   Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
   Why: The aim shapes how much side effect and disruption is worth accepting.
3. Which side effects of Pembrolizumab or Tisotumab vedotin are most likely for me, which are reversible, and which would make us stop?
   Why: The recorded rates below come from labels and trials; your own risk depends on dose, other medicines and your health.
4. What happens if I delay, or decline this step for now? Is the decision reversible?
   Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
5. Does your recommendation follow the current guideline (NCCN Guidelines: Cervical Cancer), and if it departs from it, why?
   Why: Departures from guidelines are sometimes right for an individual; they should be explained.
6. For my situation (recurrent/metastatic), which of the standard options do you recommend and why?
   Why: Guideline options include: Pembrolizumab-chemotherapy-bevacizumab; tisotumab vedotin.
7. Am I a candidate for Pembrolizumab, Tisotumab vedotin, and what side effects should I expect?
   Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Add these to your appointment list, or take the full question set for this cancer.

• KEN SHE (single-dose HPV vaccine)Phase 4NCT0367525620222,275 peopleevidence 75
  Tests HPV & HBV vaccination, Nonavalent HPV vaccine
  Kenyan women aged 15-20: single dose of bivalent or nonavalent HPV vaccine vs meningococcal control, endpoint persistent HPV16/18 infection

  Single-dose efficacy 97.5% against persistent HPV16/18.

  Vaccine efficacy against persistent HPV16/18 infection (%): Single dose nonavalent HPV 97.5 · source

1. Between HPV & HBV vaccination and Nonavalent HPV vaccine, which do you recommend for me, and what about my case would make you choose differently?
   Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
   Why: The aim shapes how much side effect and disruption is worth accepting.
3. How closely do I match the people in KEN SHE (single-dose HPV vaccine), and does that change what the results mean for me?
   Why: Trial populations are selected; age, fitness, prior treatment and biomarkers all affect how far results carry.
4. What happens if I delay, or decline this step for now? Is the decision reversible?
   Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
5. Does your recommendation follow the current guideline, and if it departs from it, why?
   Why: Departures from guidelines are sometimes right for an individual; they should be explained.
6. For my situation (primary prevention), which of the standard options do you recommend and why?
   Why: Guideline options include: HPV vaccination of girls (and boys) at 9-14, one or two doses per WHO; catch-up to 26 (US label to 45). Reduces invasive cancer ~90% when given before exposure.
7. Am I a candidate for Nonavalent HPV vaccine, and what side effects should I expect?
   Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
8. How do the results of KEN SHE (single-dose HPV vaccine) apply to someone like me?
   Why: Trial populations differ from individual patients; ask how closely you match.

Add these to your appointment list, or take the full question set for this cancer.

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

1. Between HPV DNA testing and self-sampling, Thermal ablation and cryotherapy for cervical precancer and Colposcopy and excisional treatment (LEEP/LLETZ, cone), which do you recommend for me, and what about my case would make you choose differently?
   Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
   Why: The aim shapes how much side effect and disruption is worth accepting.
3. What happens if I delay, or decline this step for now? Is the decision reversible?
   Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
4. Does your recommendation follow the current guideline, and if it departs from it, why?
   Why: Departures from guidelines are sometimes right for an individual; they should be explained.
5. For my situation (screening), which of the standard options do you recommend and why?
   Why: Guideline options include: HPV primary testing every 5 years from 25-30 (self-sampling accepted), or cytology every 3 years; VIA or HPV screen-and-treat in low-resource settings; WHO target 70% screened twice in a lifetime.

Add these to your appointment list, or take the full question set for this cancer.

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

1. Between Colposcopy and excisional treatment (LEEP/LLETZ, cone) and Thermal ablation and cryotherapy for cervical precancer, which do you recommend for me, and what about my case would make you choose differently?
   Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
   Why: The aim shapes how much side effect and disruption is worth accepting.
3. What happens if I delay, or decline this step for now? Is the decision reversible?
   Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
4. Does your recommendation follow the current guideline, and if it departs from it, why?
   Why: Departures from guidelines are sometimes right for an individual; they should be explained.
5. For my situation (precancer (hsil / cin2-3, ais)), which of the standard options do you recommend and why?
   Why: Guideline options include: Colposcopy-directed biopsy then LEEP/LLETZ or cone excision; thermal ablation or cryotherapy where eligible; HPV test of cure at 6-12 months.

Add these to your appointment list, or take the full question set for this cancer.

• SENTICOL IIIPhase 3NCT03386734evidence 30
  Tests Sentinel lymph node biopsy
  Early-stage cervical cancer: sentinel lymph node biopsy alone vs sentinel node plus full pelvic lymphadenectomy

  No headline result recorded yet.

1. Between Robotic & minimally invasive surgery and Sentinel lymph node biopsy, which do you recommend for me, and what about my case would make you choose differently?
   Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
   Why: The aim shapes how much side effect and disruption is worth accepting.
3. How closely do I match the people in SENTICOL III, and does that change what the results mean for me?
   Why: Trial populations are selected; age, fitness, prior treatment and biomarkers all affect how far results carry.
4. What happens if I delay, or decline this step for now? Is the decision reversible?
   Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
5. Does your recommendation follow the current guideline, and if it departs from it, why?
   Why: Departures from guidelines are sometimes right for an individual; they should be explained.
6. For my situation (stage ia1-ib1 (≤2 cm)), which of the standard options do you recommend and why?
   Why: Guideline options include: Simple hysterectomy is non-inferior to radical for low-risk IA2-IB1 ≤2 cm (SHAPE trial, 2024); cone or trachelectomy for fertility preservation; sentinel node mapping in trials (SENTICOL III).
7. How do the results of SENTICOL III apply to someone like me?
   Why: Trial populations differ from individual patients; ask how closely you match.

Add these to your appointment list, or take the full question set for this cancer.

• LACC (Laparoscopic Approach to Cervical Cancer)Phase 3NCT006142112018636 peopleevidence 48
  Early-stage cervical cancer (IA1 with LVSI to IB1): minimally invasive vs open radical hysterectomy
  ▸Show survival figures (1)

  Averages across everyone diagnosed, often years ago. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.

  • 4.5-year DFS 86.0% vs 96.5%; death HR 6.00 with MIS.
  Disease-free survival at 4.5 years (%): Minimally invasive 86 (n=319) vs Open surgery 96.5 (n=312) · HR 3.74 · source

1. Between IMRT / IGRT (modern external beam) and Cisplatin, which do you recommend for me, and what about my case would make you choose differently?
   Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
   Why: The aim shapes how much side effect and disruption is worth accepting.
3. How closely do I match the people in LACC (Laparoscopic Approach to Cervical Cancer), and does that change what the results mean for me?
   Why: Trial populations are selected; age, fitness, prior treatment and biomarkers all affect how far results carry.
4. What happens if I delay, or decline this step for now? Is the decision reversible?
   Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
5. Does your recommendation follow the current guideline, and if it departs from it, why?
   Why: Departures from guidelines are sometimes right for an individual; they should be explained.
6. For my situation (stage ib2-iia (surgical candidates)), which of the standard options do you recommend and why?
   Why: Guideline options include: Open radical hysterectomy with pelvic lymphadenectomy (minimally invasive approach inferior in LACC); adjuvant radiation or chemoradiation for intermediate/high-risk pathology (Sedlis, Peters criteria).
7. Am I a candidate for Cisplatin, and what side effects should I expect?
   Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
8. How do the results of LACC (Laparoscopic Approach to Cervical Cancer) apply to someone like me?
   Why: Trial populations differ from individual patients; ask how closely you match.

Add these to your appointment list, or take the full question set for this cancer.

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

1. Between Cisplatin, IMRT / IGRT (modern external beam) and Brachytherapy, which do you recommend for me, and what about my case would make you choose differently?
   Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
   Why: The aim shapes how much side effect and disruption is worth accepting.
3. What happens if I delay, or decline this step for now? Is the decision reversible?
   Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
4. Does your recommendation follow the current guideline, and if it departs from it, why?
   Why: Departures from guidelines are sometimes right for an individual; they should be explained.
5. For my situation (locally advanced (ib3, iib-iva), standard), which of the standard options do you recommend and why?
   Why: Guideline options include: Weekly cisplatin 40 mg/m² with external-beam IMRT/IGRT followed by image-guided brachytherapy to ≥85 Gy EQD2, completed within 56 days.
6. Am I a candidate for Cisplatin, and what side effects should I expect?
   Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Add these to your appointment list, or take the full question set for this cancer.

• KEYNOTE-A18 / ENGOT-cx11 / GOG-3047Phase 3NCT0422194520231,060 peopleevidence 89
  Tests Pembrolizumab
  Newly diagnosed high-risk locally advanced cervical cancer (FIGO 2014 IB2-IIB node-positive or III-IVA): pembrolizumab + cisplatin chemoradiation + brachytherapy, then pembrolizumab, vs chemoradiation

  PFS HR 0.70; 36-month OS 82.6% vs 74.8% (HR 0.67).

  Progression-free survival at 24 months (%): Pembrolizumab + CRT 68 (n=529) vs Placebo + CRT 57 (n=531) · HR 0.7 · source
• INTERLACEPhase 3NCT015662402023500 peopleevidence 87
  Locally advanced cervical cancer: 6 weeks of induction carboplatin-paclitaxel before chemoradiation vs chemoradiation alone
  ▸Show survival figures (1)

  Averages across everyone diagnosed, often years ago. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.

  • 5-year OS 80% vs 72% (HR 0.60); PFS HR 0.65.
  Progression-free survival at 5 years (%): Induction chemo + CRT 72 (n=250) vs CRT alone 64 (n=250) · HR 0.65 · source
• OUTBACK / ANZGOG 0902 / GOG-0274Phase 3NCT014146082021926 peopleevidence 50
  Locally advanced cervical cancer: chemoradiation followed by 4 cycles adjuvant carboplatin-paclitaxel vs chemoradiation alone
  ▸Show survival figures (1)

  Averages across everyone diagnosed, often years ago. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.

  • 5-year OS 72% vs 71%; no benefit.
  Overall survival at 5 years (%): CRT + adjuvant chemo 72 (n=463) vs CRT alone 71 (n=456) · HR 0.91 · source

1. Is Pembrolizumab the only reasonable path for me, or is there a trial, a different sequence or a wait-and-see option?
   Why: A single standard does not mean a single choice; timing and trials are decisions too.
2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
   Why: The aim shapes how much side effect and disruption is worth accepting.
3. How closely do I match the people in KEYNOTE-A18 / ENGOT-cx11 / GOG-3047 and INTERLACE, and does that change what the results mean for me?
   Why: Trial populations are selected; age, fitness, prior treatment and biomarkers all affect how far results carry.
4. Which side effects of Pembrolizumab are most likely for me, which are reversible, and which would make us stop?
   Why: The recorded rates below come from labels and trials; your own risk depends on dose, other medicines and your health.
5. What happens if I delay, or decline this step for now? Is the decision reversible?
   Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
6. Does your recommendation follow the current guideline, and if it departs from it, why?
   Why: Departures from guidelines are sometimes right for an individual; they should be explained.
7. For my situation (locally advanced, high risk (node-positive ib2-iib, iii-iva)), which of the standard options do you recommend and why?
   Why: Guideline options include: Add pembrolizumab during chemoradiation and for 15 maintenance cycles (KEYNOTE-A18, approved 2024 for FIGO III-IVA), or induction carboplatin-paclitaxel weekly × 6 before chemoradiation (INTERLACE). Adjuvant chemotherapy after chemoradiation is not recommended (OUTBACK).
8. Am I a candidate for Pembrolizumab, and what side effects should I expect?
   Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
9. How do the results of KEYNOTE-A18 / ENGOT-cx11 / GOG-3047 and INTERLACE apply to someone like me?
   Why: Trial populations differ from individual patients; ask how closely you match.

Add these to your appointment list, or take the full question set for this cancer.

• KEYNOTE-826Phase 3NCT036355672021617 peopleevidence 94
  Tests Pembrolizumab, Bevacizumab
  Persistent, recurrent, or metastatic cervical cancer, first line: pembrolizumab + platinum-paclitaxel ± bevacizumab vs placebo + chemotherapy ± bevacizumab

  OS 26.4 vs 16.8 months (HR 0.63), all comers.

  Overall survival (all comers) (months): Pembrolizumab + chemo ± bev 26.4 (n=308) vs Placebo + chemo ± bev 16.8 (n=309) · HR 0.63 · source
• BEATcc / ENGOT-Cx10 / GOG-3030Phase 3NCT035568392023410 peopleevidence 77
  Tests Bevacizumab, Atezolizumab
  Metastatic, persistent, or recurrent cervical cancer, first line: atezolizumab + cisplatin/carboplatin-paclitaxel + bevacizumab vs the same without atezolizumab

  OS 32.1 vs 22.8 months (HR 0.68).

  Progression-free survival (months): Atezolizumab + chemo + bev 13.7 (n=206) vs Chemo + bev 10.4 (n=204) · HR 0.62 · source
• COMPASSION-16 / AK104-303Phase 3NCT049822372024445 peopleevidence 77
  Tests Bevacizumab, Cadonilimab
  Persistent, recurrent, or metastatic cervical cancer, first line (China): cadonilimab (PD-1×CTLA-4 bispecific) + platinum-paclitaxel ± bevacizumab vs placebo + chemotherapy ± bevacizumab

  OS HR 0.64; PFS HR 0.62.

1. Between Pembrolizumab, Bevacizumab, Atezolizumab and the other options, which do you recommend for me, and what about my case would make you choose differently?
   Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
   Why: The aim shapes how much side effect and disruption is worth accepting.
3. How closely do I match the people in KEYNOTE-826 and BEATcc / ENGOT-Cx10 / GOG-3030, and does that change what the results mean for me?
   Why: Trial populations are selected; age, fitness, prior treatment and biomarkers all affect how far results carry.
4. Which side effects of Pembrolizumab or Atezolizumab are most likely for me, which are reversible, and which would make us stop?
   Why: The recorded rates below come from labels and trials; your own risk depends on dose, other medicines and your health.
5. What happens if I delay, or decline this step for now? Is the decision reversible?
   Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
6. Does your recommendation follow the current guideline, and if it departs from it, why?
   Why: Departures from guidelines are sometimes right for an individual; they should be explained.
7. For my situation (persistent, recurrent, or metastatic, first line), which of the standard options do you recommend and why?
   Why: Guideline options include: Pembrolizumab + cisplatin/carboplatin-paclitaxel ± bevacizumab (KEYNOTE-826, CPS ≥1 in the US); atezolizumab + chemotherapy + bevacizumab (BEATcc, region-dependent); cadonilimab + chemotherapy in China (COMPASSION-16).
8. Am I a candidate for Pembrolizumab, Bevacizumab, Atezolizumab or related drugs, and what side effects should I expect?
   Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
9. How do the results of KEYNOTE-826 and BEATcc / ENGOT-Cx10 / GOG-3030 apply to someone like me?
   Why: Trial populations differ from individual patients; ask how closely you match.

Add these to your appointment list, or take the full question set for this cancer.

• innovaTV 301 / ENGOT-cx12 / GOG-3057Phase 3NCT046976282023502 peopleevidence 84
  Tests Tisotumab vedotin
  Recurrent or metastatic cervical cancer after 1-2 prior lines including platinum: tisotumab vedotin vs investigator's-choice chemotherapy

  OS 11.5 vs 9.5 months (HR 0.70).

  Overall survival (months): Tisotumab vedotin 11.5 (n=253) vs Chemotherapy 9.5 (n=249) · HR 0.7 · source
• EMPOWER-Cervical 1 / GOG-3016 / ENGOT-cx9Phase 3NCT032572672021608 peopleevidence 84
  Tests Cemiplimab
  Recurrent cervical cancer after first-line platinum: cemiplimab vs single-agent chemotherapy

  OS 12.0 vs 8.5 months (HR 0.69).

  Overall survival (months): Cemiplimab 12 (n=304) vs Chemotherapy 8.5 (n=304) · HR 0.69 · source
• DESTINY-PanTumor02Phase 2NCT044823092023267 peopleevidence 55
  Tests Trastuzumab deruxtecan
  HER2-expressing (IHC 2+/3+) solid tumours after ≥1 line, seven cohorts including endometrial and cervical: trastuzumab deruxtecan

  Endometrial ORR 57.5% (84.6% in IHC 3+); cervical ORR 50%.

  Objective response rate, endometrial cohort (%): T-DXd (all HER2 IHC 2+/3+) 57.5 (n=40) vs T-DXd (IHC 3+ only) 84.6 (n=13) · source

1. Between Tisotumab vedotin, Cemiplimab, Trastuzumab deruxtecan and the other options, which do you recommend for me, and what about my case would make you choose differently?
   Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
   Why: The aim shapes how much side effect and disruption is worth accepting.
3. How closely do I match the people in innovaTV 301 / ENGOT-cx12 / GOG-3057 and EMPOWER-Cervical 1 / GOG-3016 / ENGOT-cx9, and does that change what the results mean for me?
   Why: Trial populations are selected; age, fitness, prior treatment and biomarkers all affect how far results carry.
4. Which side effects of Tisotumab vedotin or Trastuzumab deruxtecan are most likely for me, which are reversible, and which would make us stop?
   Why: The recorded rates below come from labels and trials; your own risk depends on dose, other medicines and your health.
5. What happens if I delay, or decline this step for now? Is the decision reversible?
   Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
6. Does your recommendation follow the current guideline, and if it departs from it, why?
   Why: Departures from guidelines are sometimes right for an individual; they should be explained.
7. For my situation (second line and beyond), which of the standard options do you recommend and why?
   Why: Guideline options include: Tisotumab vedotin (innovaTV 301, OS benefit); cemiplimab if immunotherapy-naive (EU); T-DXd for HER2 IHC 3+; pembrolizumab for MSI-H/TMB-high; single-agent chemotherapy; trials of sac-TMT and TIL therapy.
8. Am I a candidate for Tisotumab vedotin, Cemiplimab, Trastuzumab deruxtecan or related drugs, and what side effects should I expect?
   Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
9. How do the results of innovaTV 301 / ENGOT-cx12 / GOG-3057 and EMPOWER-Cervical 1 / GOG-3016 / ENGOT-cx9 apply to someone like me?
   Why: Trial populations differ from individual patients; ask how closely you match.

Add these to your appointment list, or take the full question set for this cancer.

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

1. Between Robotic & minimally invasive surgery, Brachytherapy and Proton therapy, which do you recommend for me, and what about my case would make you choose differently?
   Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
   Why: The aim shapes how much side effect and disruption is worth accepting.
3. What happens if I delay, or decline this step for now? Is the decision reversible?
   Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
4. Does your recommendation follow the current guideline, and if it departs from it, why?
   Why: Departures from guidelines are sometimes right for an individual; they should be explained.
5. For my situation (pelvic recurrence after radiation), which of the standard options do you recommend and why?
   Why: Guideline options include: Pelvic exenteration in selected patients with central recurrence; re-irradiation with brachytherapy or proton therapy in specialised centres.

Add these to your appointment list, or take the full question set for this cancer.