Establish intent of treatment:

• curative
• anti-cancer therapy to improve quality of life and/or longevity without expectation of cure
• symptom palliation.

Where possible, avoid sequential multimodality treatment.

Treatment options

Surgery: Surgery is typically reserved for women who have small tumours found only within the cervix (early-stage disease and smaller lesions). In selected cases surgery for fertility preservation may be possible.

Radiation therapy: Concurrent chemoradiation is generally the primary treatment of choice if it is anticipated that surgery will not remove all disease. In women with high-risk disease, postoperative radiation therapy plus/minus chemotherapy following surgery should be offered. Where possible, these patients should be identified upfront and considered for definitive chemoradiation to minimise the toxicities of trimodality treatment.

Chemotherapy and other systemic therapy: Chemotherapy may be used as part of primary chemoradiation or adjuvant chemoradiation. It may also be used as neoadjuvant treatment in patients who have metastatic disease outside of the pelvis.

For more information refer to the 2016 Cervical Cancer Screening guidelines.

Palliative care: Early referral can improve quality of life. Referral should be based on need, not prognosis.

Communication – lead clinician to:

• discuss treatment options with the woman/carer including the intent of treatment and expected outcomes
• discuss advance care planning with the woman/carer where appropriate
• discuss the treatment plan with the woman’s general practitioner.