Appointment sheet
Cervical cancer
Prepared with OnCo (onco.cc/prep/cervical/). Orientation, not medical advice; your team knows your case.
My details
Name
Date of appointment
Hospital and clinician
Who is coming with me
What I know, what is unclear, changes to discuss
Saved in this browserWhat I know so far
What is unclear to me
Changes since last time
My questions
36 on the sheetNewly diagnosed
- 1.What is my exact diagnosis, stage, and grade, and which tests established them?
- 2.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?
- 3.Which subtype is my cancer, and does that change the recommended treatment?
- 4.Is germline (inherited) genetic testing recommended for me or my family?
Prevention
- 5.For my situation (prevention), which of the standard options do you recommend and why?
Locally advanced
- 6.For my situation (locally advanced), which of the standard options do you recommend and why?
- 7.Am I a candidate for Pembrolizumab, and what side effects should I expect?
Recurrent/metastatic
- 8.For my situation (recurrent/metastatic), which of the standard options do you recommend and why?
- 9.Am I a candidate for Pembrolizumab, Tisotumab vedotin, and what side effects should I expect?
Primary prevention
- 10.For my situation (primary prevention), which of the standard options do you recommend and why?
- 11.Am I a candidate for Nonavalent HPV vaccine, and what side effects should I expect?
- 12.How do the results of KEN SHE (single-dose HPV vaccine) apply to someone like me?
Screening
- 13.For my situation (screening), which of the standard options do you recommend and why?
Precancer (HSIL / CIN2-3, AIS)
- 14.For my situation (precancer (hsil / cin2-3, ais)), which of the standard options do you recommend and why?
Stage IA1-IB1 (≤2 cm)
- 15.For my situation (stage ia1-ib1 (≤2 cm)), which of the standard options do you recommend and why?
- 16.How do the results of SENTICOL III apply to someone like me?
Stage IB2-IIA (surgical candidates)
- 17.For my situation (stage ib2-iia (surgical candidates)), which of the standard options do you recommend and why?
- 18.Am I a candidate for Cisplatin, and what side effects should I expect?
- 19.How do the results of LACC (Laparoscopic Approach to Cervical Cancer) apply to someone like me?
Locally advanced (IB3, IIB-IVA), standard
- 20.For my situation (locally advanced (ib3, iib-iva), standard), which of the standard options do you recommend and why?
- 21.Am I a candidate for Cisplatin, and what side effects should I expect?
Locally advanced, high risk (node-positive IB2-IIB, III-IVA)
- 22.For my situation (locally advanced, high risk (node-positive ib2-iib, iii-iva)), which of the standard options do you recommend and why?
- 23.Am I a candidate for Pembrolizumab, and what side effects should I expect?
- 24.How do the results of KEYNOTE-A18 / ENGOT-cx11 / GOG-3047 and INTERLACE apply to someone like me?
Persistent, recurrent, or metastatic, first line
- 25.For my situation (persistent, recurrent, or metastatic, first line), which of the standard options do you recommend and why?
- 26.Am I a candidate for Pembrolizumab, Bevacizumab, Atezolizumab or related drugs, and what side effects should I expect?
- 27.How do the results of KEYNOTE-826 and BEATcc / ENGOT-Cx10 / GOG-3030 apply to someone like me?
Second line and beyond
- 28.For my situation (second line and beyond), which of the standard options do you recommend and why?
- 29.Am I a candidate for Tisotumab vedotin, Cemiplimab, Trastuzumab deruxtecan or related drugs, and what side effects should I expect?
- 30.How do the results of innovaTV 301 / ENGOT-cx12 / GOG-3057 and EMPOWER-Cervical 1 / GOG-3016 / ENGOT-cx9 apply to someone like me?
Pelvic recurrence after radiation
- 31.For my situation (pelvic recurrence after radiation), which of the standard options do you recommend and why?
Any stage
- 32.Are there clinical trials I could join, for example of Sacituzumab tirumotecan, Lifileucel, SHR-8068, SHR-A2102?
- 33.Would a second opinion at a high-volume centre change anything, and can you help arrange it?
- 34.What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?
- 35.I read that “Vaccine and screening access in LMICs”. How does that affect my plan?
- 36.I read that “Brachytherapy capacity”. How does that affect my plan?
The words I may hear
- 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.
Tests and results to bring
Biomarker results to ask for: HPV type, PD-L1 CPS, Tissue factor (not required), High-risk HPV type (16, 18, others) and HPV status (HPV-independent tumours behave worse), PD-L1 CPS (≥1 for pembrolizumab in recurrent disease; not required for KEYNOTE-A18), p16 IHC (HPV surrogate), HER2 (IHC 3+ for T-DXd; ~5-10%), Tissue factor (not required for tisotumab), Plasma HPV ctDNA (investigational monitoring), FIGO 2018 stage incorporating imaging and nodal status, MSI/TMB (rare tumour-agnostic eligibility).
Scans and tests linked to this cancer: Colposcopy and excisional treatment (LEEP/LLETZ, cone), Companion diagnostics, Histopathology & immunohistochemistry, HPV DNA testing and self-sampling, In-room imaging for radiotherapy (cone-beam CT, ExacTrac, CT-on-rails, HyperSight), Liquid biopsy (ctDNA).
Bring copies of scan reports, pathology and blood results, and a list of every medicine and supplement.
The treatments I may be offered
- Prevention: HPV vaccination age 9-14; HPV primary screening. (HPV & HBV vaccination)
- Primary prevention: 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 & HBV vaccination, Nonavalent HPV vaccine, KEN SHE (single-dose HPV vaccine))
- Screening: 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. (HPV DNA testing and self-sampling, Thermal ablation and cryotherapy for cervical precancer, Colposcopy and excisional treatment (LEEP/LLETZ, cone))
- Locally advanced: Cisplatin chemoradiation + brachytherapy + pembrolizumab. (Brachytherapy, IMRT / IGRT (modern external beam), Pembrolizumab)
- Locally advanced (IB3, IIB-IVA), standard: Weekly cisplatin 40 mg/m² with external-beam IMRT/IGRT followed by image-guided brachytherapy to ≥85 Gy EQD2, completed within 56 days. (Cisplatin, IMRT / IGRT (modern external beam), Brachytherapy)
- Locally advanced, high risk (node-positive IB2-IIB, III-IVA): 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). (KEYNOTE-A18 / ENGOT-cx11 / GOG-3047, Pembrolizumab, INTERLACE, Induction chemotherapy → chemoradiation (locally advanced cervical cancer), PD-1 blockade + chemoradiation (locally advanced cervical cancer), OUTBACK / ANZGOG 0902 / GOG-0274)
- Recurrent/metastatic: Pembrolizumab-chemotherapy-bevacizumab; tisotumab vedotin. (Pembrolizumab, Tisotumab vedotin)
- Precancer (HSIL / CIN2-3, AIS): Colposcopy-directed biopsy then LEEP/LLETZ or cone excision; thermal ablation or cryotherapy where eligible; HPV test of cure at 6-12 months. (Colposcopy and excisional treatment (LEEP/LLETZ, cone), Thermal ablation and cryotherapy for cervical precancer, Cervical precancer (CIN, HSIL/LSIL))
- Stage IA1-IB1 (≤2 cm): 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). (Robotic & minimally invasive surgery, Sentinel lymph node biopsy, SENTICOL III)
- Stage IB2-IIA (surgical candidates): Open radical hysterectomy with pelvic lymphadenectomy (minimally invasive approach inferior in LACC); adjuvant radiation or chemoradiation for intermediate/high-risk pathology (Sedlis, Peters criteria). (LACC (Laparoscopic Approach to Cervical Cancer), Caution: minimally invasive radical hysterectomy for early cervical cancer, IMRT / IGRT (modern external beam), Cisplatin)
- Persistent, recurrent, or metastatic, first line: Pembrolizumab + cisplatin/carboplatin-paclitaxel ± bevacizumab (KEYNOTE-826, CPS ≥1 in the US); atezolizumab + chemotherapy + bevacizumab (BEATcc, region-dependent); cadonilimab + chemotherapy in China (COMPASSION-16). (KEYNOTE-826, Pembrolizumab, Bevacizumab, BEATcc / ENGOT-Cx10 / GOG-3030, Atezolizumab, COMPASSION-16 / AK104-303, Cadonilimab)
- Pelvic recurrence after radiation: Pelvic exenteration in selected patients with central recurrence; re-irradiation with brachytherapy or proton therapy in specialised centres. (Robotic & minimally invasive surgery, Brachytherapy, Proton therapy)
- Second line and beyond: 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. (Tisotumab vedotin, innovaTV 301 / ENGOT-cx12 / GOG-3057, Cemiplimab, EMPOWER-Cervical 1 / GOG-3016 / ENGOT-cx9, Trastuzumab deruxtecan, DESTINY-PanTumor02, Sacituzumab tirumotecan, Lifileucel)
From the standard of care recorded for this cancer; which apply depends on your stage and biomarkers. Ask which the team recommends and why.
Answers and next steps
Saved in this browserWhat I was told
Agreed next steps, dates and who to call