Responsibility for follow-up care should be agreed between the lead clinician, the general practitioner, relevant members of the multidisciplinary team and the woman, with an agreed plan documented that outlines:

• what medical follow-up is required (surveillance for cancer spread, recurrence or secondary cancers, screening and assessment for medical and psychosocial effects)
• care plans from other health professionals to manage the consequences of cancer and treatment
• a process for rapid re-entry to specialist medical services for suspected recurrence.

No definitive agreement exists on the best post-treatment follow-up. The options for follow-up should be discussed at the completion of the primary treatment. Some women will decide that the psychological trauma of follow-up is too unsettling and opt to attend follow-up visits only if they have symptoms. Some women may opt out of specialist follow-up. Others will be keen for surveillance, even though some may experience anxiety prior to the follow-up visits.

The following recommendations are based on expert advice from the Cervical Cancer Working Group:

• Clinical review including vaginal examination should take place.
• Vaginal vault cytology* and imaging should be performed as clinically indicated with an annual co-test (HPV and cytology). For example: three-monthly for the first two years, six-monthly in the
• third and fourth year, with a final review at five years. Thereafter, all women should have an annual co-test with a general practitioner.
• CT, MRI or PET/CT scan should be performed as clinically indicated (ESMO Guidelines Working Group 2012).
• Access to a range of health professionals may be required, including providing an end-of-treatment care plan.

Special circumstances

Following fertility preserving surgery:

• In year 1 of follow-up, a colposcopy is recommended every three months. Cytology and HPV testing (co-test) at 12 months.
• In year 2 and 3 of follow-up, a six-monthly colposcopy is recommended. An annual co-test is recommended for all women.
• In year 4 and 5 of follow-up, an annual colposcopy is recommended. An annual co-test is recommended for all women.
• Women should be advised to consider a hysterectomy when fertility is no longer required.

Following primary chemoradiation treatment:

• *Cytology should be avoided following treatment unless clinically indicated because of the high rate of false-positive results.