The first 60 days: Cervical cancer
A cancer that could be eliminated by HPV vaccination and screening. For those who develop it, immunotherapy and a tissue-factor ADC have improved survival. Below, week by week, is what OnCo's record of Cervical cancer says about the first two months: the order is typical, the timing is yours to ask about. Sections appear only where the record has something to say. Orientation, not medical advice.
What happens now
Staging tests establish exactly what and where the cancer is. Everything else follows from the answers.
Ask which of these were tested and what the results were; see the report reader for what each value means.
These specialties appear in the standard of care for this cancer. In most centres they meet weekly as a tumour board to agree each plan; you can ask when yours was discussed and what was decided.
- PathologistNamed in the standard of care for: Screening, Precancer (HSIL / CIN2-3, AIS), Stage IB2-IIA (surgical candidates), Persistent, recurrent, or metastatic, first line and 1 more.
- SurgeonNamed in the standard of care for: Screening, Precancer (HSIL / CIN2-3, AIS), Stage IA1-IB1 (≤2 cm), Stage IB2-IIA (surgical candidates) and 1 more.
- Medical oncologistNamed in the standard of care for: Locally advanced, Recurrent/metastatic, Primary prevention, Precancer (HSIL / CIN2-3, AIS) and 6 more.
- Clinical oncologist (radiotherapy)Named in the standard of care for: Locally advanced, Stage IB2-IIA (surgical candidates), Locally advanced (IB3, IIB-IVA), standard, Locally advanced, high risk (node-positive IB2-IIB, III-IVA) and 1 more.
- Transplant and cell therapy teamNamed in the standard of care for: Second line and beyond.
A second opinion from a centre that treats many similar cases is normal, not rude; the standard of care tells you what to compare it against.
Each row is a setting from the standard of care, in the order it usually arises. Not all will apply to you; your stage and biomarkers decide which do. The guideline grade, where recorded, says how strong the evidence is.
HPV vaccination age 9-14; HPV primary screening.
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.
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.
Cisplatin chemoradiation + brachytherapy + pembrolizumab.
Weekly cisplatin 40 mg/m² with external-beam IMRT/IGRT followed by image-guided brachytherapy to ≥85 Gy EQD2, completed within 56 days.
- 6.Locally advanced, high risk (node-positive IB2-IIB, III-IVA)NCCN category 1 (pembrolizumab); 2A (induction), ESMO-MCBS A (KEYNOTE-A18)
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).
- 7.Recurrent/metastaticESMO-MCBS 2 (innovaTV 204 tisotumab vedotin, single-arm), NCCN Guidelines: Cervical Cancer
Pembrolizumab-chemotherapy-bevacizumab; tisotumab vedotin.
Colposcopy-directed biopsy then LEEP/LLETZ or cone excision; thermal ablation or cryotherapy where eligible; HPV test of cure at 6-12 months.
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).
Open radical hysterectomy with pelvic lymphadenectomy (minimally invasive approach inferior in LACC); adjuvant radiation or chemoradiation for intermediate/high-risk pathology (Sedlis, Peters criteria).
Pembrolizumab + cisplatin/carboplatin-paclitaxel ± bevacizumab (KEYNOTE-826, CPS ≥1 in the US); atezolizumab + chemotherapy + bevacizumab (BEATcc, region-dependent); cadonilimab + chemotherapy in China (COMPASSION-16).
Pelvic exenteration in selected patients with central recurrence; re-irradiation with brachytherapy or proton therapy in specialised centres.
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.
Generated from this cancer's standard of care, biomarkers and open problems. Take the group that matches where you are. To tick, add your own and print, open the one-page appointment sheet.
Newly diagnosed
- What is my exact diagnosis, stage, and grade, and which tests established them?Everything else follows from an accurate stage and subtype.
- Which biomarkers have been tested on my tumour (for example HPV type, PD-L1 CPS, Tissue factor, High-risk HPV typeand HPV status, PD-L1 CPS), and what were the results?These results decide eligibility for targeted therapy, immunotherapy, and trials.
- Which subtype is my cancer, and does that change the recommended treatment?Recognised subtypes for this cancer include Squamous cell carcinoma, Adenocarcinoma, Adenosquamous carcinoma.
- Is germline (inherited) genetic testing recommended for me or my family?Inherited variants can change treatment and matter for relatives.
Prevention
- For my situation (prevention), which of the standard options do you recommend and why?Guideline options include: HPV vaccination age 9-14; HPV primary screening.
Locally advanced
- For my situation (locally advanced), which of the standard options do you recommend and why?Guideline options include: Cisplatin chemoradiation + brachytherapy + pembrolizumab.
- Am I a candidate for Pembrolizumab, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
Recurrent/metastatic
- For my situation (recurrent/metastatic), which of the standard options do you recommend and why?Guideline options include: Pembrolizumab-chemotherapy-bevacizumab; tisotumab vedotin.
- Am I a candidate for Pembrolizumab, Tisotumab vedotin, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
Primary prevention
- For my situation (primary prevention), which of the standard options do you recommend and 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.
- Am I a candidate for Nonavalent HPV vaccine, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of KEN SHE (single-dose HPV vaccine) apply to someone like me?Trial populations differ from individual patients; ask how closely you match.
Screening
- For my situation (screening), which of the standard options do you recommend and 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.
Precancer (HSIL / CIN2-3, AIS)
- For my situation (precancer (hsil / cin2-3, ais)), which of the standard options do you recommend and 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.
Stage IA1-IB1 (≤2 cm)
- For my situation (stage ia1-ib1 (≤2 cm)), which of the standard options do you recommend and 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).
- How do the results of SENTICOL III apply to someone like me?Trial populations differ from individual patients; ask how closely you match.
Stage IB2-IIA (surgical candidates)
- For my situation (stage ib2-iia (surgical candidates)), which of the standard options do you recommend and 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).
- Am I a candidate for Cisplatin, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of LACC (Laparoscopic Approach to Cervical Cancer) apply to someone like me?Trial populations differ from individual patients; ask how closely you match.
Locally advanced (IB3, IIB-IVA), standard
- For my situation (locally advanced (ib3, iib-iva), standard), which of the standard options do you recommend and 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.
- Am I a candidate for Cisplatin, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
Locally advanced, high risk (node-positive IB2-IIB, III-IVA)
- For my situation (locally advanced, high risk (node-positive ib2-iib, iii-iva)), which of the standard options do you recommend and 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).
- Am I a candidate for Pembrolizumab, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of KEYNOTE-A18 / ENGOT-cx11 / GOG-3047 and INTERLACE apply to someone like me?Trial populations differ from individual patients; ask how closely you match.
Persistent, recurrent, or metastatic, first line
- For my situation (persistent, recurrent, or metastatic, first line), which of the standard options do you recommend and 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).
- Am I a candidate for Pembrolizumab, Bevacizumab, Atezolizumab or related drugs, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of KEYNOTE-826 and BEATcc / ENGOT-Cx10 / GOG-3030 apply to someone like me?Trial populations differ from individual patients; ask how closely you match.
Second line and beyond
- For my situation (second line and beyond), which of the standard options do you recommend and 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.
- Am I a candidate for Tisotumab vedotin, Cemiplimab, Trastuzumab deruxtecan or related drugs, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of innovaTV 301 / ENGOT-cx12 / GOG-3057 and EMPOWER-Cervical 1 / GOG-3016 / ENGOT-cx9 apply to someone like me?Trial populations differ from individual patients; ask how closely you match.
Pelvic recurrence after radiation
- For my situation (pelvic recurrence after radiation), which of the standard options do you recommend and why?Guideline options include: Pelvic exenteration in selected patients with central recurrence; re-irradiation with brachytherapy or proton therapy in specialised centres.
Any stage
- Are there clinical trials I could join, for example of Sacituzumab tirumotecan, Lifileucel, SHR-8068, SHR-A2102?Trials are how the next standard of care is set; asking early keeps options open.
- Would a second opinion at a high-volume centre change anything, and can you help arrange it?Rare or high-stakes decisions benefit from a centre that treats many similar patients.
- What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?Supportive care improves quality of life and helps patients complete treatment.
- I read that “Vaccine and screening access in LMICs”. How does that affect my plan?Open problems are where trials and second opinions matter most.
- I read that “Brachytherapy capacity”. How does that affect my plan?Open problems are where trials and second opinions matter most.
Trials open now for this cancer in OnCo, largest phase first. Joining a trial is a decision like any other: ask what the comparison arm is, whether a placebo is used, and what happens if you leave. The cancer page searches ClinicalTrials.gov live for more.
- A Clinical Study of Sacituzumab Tirumotecan (MK-2870) in Combination With Pembrolizumab (MK-3475) as First-line Maintenance Treatment of Cervical CancPhase 3 · recruiting · NCT07216703A Phase 3, Randomized, Open-label, Multicenter Study to Evaluate the Efficacy and Safety of Sacituzumab Tirumotecan (MK-2870) in Combination With Pembrolizumab With or Without Bevacizumab Compared With Standard of Care as Firstline Maintenance Treatment for Participants With Persistent, Recurrent, or Newly Diagnosed Metastatic Cervical Cancer With PD-L1 CPS Greater Than or Equal to 1 (TroFuse-036/GOG-3123/ENGOT-cx22)
- A Phase III Clinical Study of Adebrelimab Combined With Concurrent Chemoradiotherapy Versus Placebo Combined With Concurrent Chemoradiotherapy for thePhase 3 · recruiting · NCT07168200A Randomized, Controlled, Double-blind, Multicenter Phase III Clinical Study of Adebrelimab Combined With Concurrent Chemoradiotherapy Versus Placebo Combined With Concurrent Chemoradiotherapy for the Treatment of Locally Advanced Cervical Cancer
- A Study of AK104/Placebo Combined With Chemoradiotherapy For The Treatment of Locally Advanced Cervical CancerPhase 3 · active · NCT05235516A Randomized, Double-blind, Placebo-controlled Phase III Study to Evaluate AK104 Combined With Chemoradiotherapy For The Treatment of Locally Advanced Cervical Cancer
- A Study of GLS-010 Plus Platinum-containing Chemotherapy±Bevacizumab as First-line Treatment for Persistent, Recurrent, or Metastatic CervicPhase 3 · recruiting · NCT05798819A Randomized, Double-blind, Placebo-controlled Phase III Study to Evaluate GLS-010 Plus Platinum-containing Chemotherapy With or Without Bevacizumab as First-line Treatment for Persistent, Recurrent, or Metastatic Cervical Cancer
- A Study of SHR-A2102 Versus Investigator's Choice of Chemotherapy in Patients With Platinum-based Chemotherapy and PD-(L)1 Inhibitor Treatment Failed Recurrent or Metastatic Cervical CancerPhase 3 · recruiting · NCT07418749An Open-label, Randomized, Controlled, Multicenter, Phase III Study of SHR-A2102 Versus Investigator's Choice of Chemotherapy in Patients With Platinum-based Chemotherapy and PD-(L)1 Inhibitor Treatment Failed Recurrent or Metastatic Cervical Cancer
Much of what helps in the first weeks is free if you know to ask: testing, helplines, rides and lodging, second opinions, trial travel.
- Cervical cancer: the full pageA cancer that could be eliminated by HPV vaccination and screening. For those who develop it, immunotherapy and a tissue-factor ADC have improved survival.
- One-page appointment sheetYour questions, the words you may hear, what to bring, and space for the answers. Print it.
- Guidelines comparedNCCN, ESMO and NICE side by side for this cancer.
- Treatment sequencingWhich treatment tends to follow which, line by line.
- NavigatorStandard of care for your stage, what you have tried, and trials near you.
- Cervical precancer (CIN, HSIL/LSIL): Abnormal cervical cells caused by HPV that can turn into cancer over 10-20 years.
- Brachytherapy (internal radiotherapy): Radiotherapy from the inside: radioactive seeds or a temporary source are placed in or next to the tumour, so the dose falls off steeply and nearby organs are spared.
- Microenvironment and inflammation: tumours as wounds that do not heal: A tumour is not a lump of cancer cells but a tissue: fibroblasts, vessels and immune cells, recruited by the signals a wound uses and never told to stop.
- Cancer vaccines and oncolytic viruses: Cancer vaccines teach the immune system to recognise proteins on tumour cells; oncolytic viruses infect and burst cancer cells while raising the alarm to immunity.
- Dysplasia (pre-cancerous change): Abnormal-looking cells in a surface lining that are not yet cancer but are on the way.
- Hysterectomy: Removing the uterus (womb), often with the cervix, tubes and ovaries.
- Squamous cell carcinoma: A carcinoma arising from the flat, layered cells that line surfaces exposed to wear: skin, mouth, throat, oesophagus, cervix, the larger airways.
- Carcinoma in situ (CIS): Cancer cells that fill the lining layer where they started but have not broken through the basement membrane into the tissue beneath.
- HPV status (HPV-positive / HPV-negative): Whether a cancer is caused by human papillomavirus.
- Cancer during pregnancy: About 1 in 1,000 pregnancies is complicated by cancer, most often breast, cervical, lymphoma, melanoma or leukaemia.
Every term links to the glossary.