, Management of Cervical Cancer (Second Edition)
Published by:
Malaysia Health Technology Assessment Section (MaHTAS)
Medical Development Division, Ministry of Health Malaysia
Level 4, Block E1, Precinct 1
Federal Government Administrative Centre
62590, Putrajaya, Malaysia
Copyright
The copyright owner of this publication is MaHTAS. Content may be
reproduced in any number of copies and in any format or medium pro-
vided that a copyright acknowledgement to MaHTAS is included and
the content is not changed, not sold, nor used to promote or endorse
any product or service, and not used in an inappropriate or misleading
context.
ISBN: 978-967-0769-27-1
Available on the following websites:
http://www.moh.gov.my
http://www.acadmed.org.my
http://www.malaysiaoncology.org
http://www.themgcs.blogspot.com
Also available as an app for Android and iOS Platform: MyMaHTAS
STATEMENT OF INTENT
These clinical practice guidelines (CPG) are meant to be guides for
clinical practice, based on the best available evidence at the time of
development. Adherence to these guidelines may not necessarily
guarantee the best outcome in every case. Every healthcare provider is
responsible for the management of his/her unique patient based on the
clinical picture presented by the patient and the management options
available locally.
These guidelines were issued in 2015 and will be reviewed in 2019 or
sooner if new evidence becomes available. When it is due for updating,
the Chairman of the CPG or National Advisor of the related specialty
will be informed about it. A discussion will be done on the need for
a revision including the scope of the revised CPG. A multidisciplinary
team will be formed and the latest systematic review methodology used
by MaHTAS will be employed.
, Management of Cervical Cancer (Second Edition)
TABLE OF CONTENTS
No. Title Page
Levels of Evidence & Formulation of Recommendation v
Guidelines Development and Objectives vi
Guidelines Development Group viii
Review Committee ix
External Reviewers x
Algorithm on Management of Cervical Cancer xi
1. INTRODUCTION 1
2. EPIDEMIOLOGY 1
3. RISK FACTORS 2
4. CLINICAL PRESENTATION 2
5. REFERRAL 3
6. DIAGNOSIS 4
7. STAGING 7
8. TREATMENT 11
9. SPECIAL CIRCUMSTANCES 21
10. FOLLOW-UP 27
11. RECURRENT DISEASE 29
12. TREATMENT COMPLICATIONS 32
13. PALLIATIVE CARE 34
14. PSYCHOSEXUAL CARE AND SUPPORT 42
15. IMPLEMENTING THE GUIDELINES 44
16. REFERENCES 46
17.
Appendix 1 Examples of Search Strategy 52
Appendix 2 Clinical Questions 53
Appendix 3 WHO histological classification of tumours 55
of the uterine cervix
, Management of Cervical Cancer (Second Edition)
No. Title Page
Appendix 4 Reporting Proforma for Cervical Cancer 57
Excisional Cervical Biopsies/Hysterectomy
Specimens
Appendix 5 Revised FIGO Cervical Cancer Staging 2009 60
Appendix 6 Modified Delgado Score for Cervical Cancer 61
Appendix 7 ECOG Performance Status 62
Appendix 8 Systemic Therapy of Cancer Protocol 63
Appendix 9 Malaysian Hospice Directory 65
Appendix 10 International Society of Lymphology (ISL) 67
Appendix 11 Distress Thermometer Screening Tool 68
Appendix 12 Medication List 69
List of Abbreviations
Acknowledgement 70
Disclosure Statement 71
Source of Funding 71
Published by:
Malaysia Health Technology Assessment Section (MaHTAS)
Medical Development Division, Ministry of Health Malaysia
Level 4, Block E1, Precinct 1
Federal Government Administrative Centre
62590, Putrajaya, Malaysia
Copyright
The copyright owner of this publication is MaHTAS. Content may be
reproduced in any number of copies and in any format or medium pro-
vided that a copyright acknowledgement to MaHTAS is included and
the content is not changed, not sold, nor used to promote or endorse
any product or service, and not used in an inappropriate or misleading
context.
ISBN: 978-967-0769-27-1
Available on the following websites:
http://www.moh.gov.my
http://www.acadmed.org.my
http://www.malaysiaoncology.org
http://www.themgcs.blogspot.com
Also available as an app for Android and iOS Platform: MyMaHTAS
STATEMENT OF INTENT
These clinical practice guidelines (CPG) are meant to be guides for
clinical practice, based on the best available evidence at the time of
development. Adherence to these guidelines may not necessarily
guarantee the best outcome in every case. Every healthcare provider is
responsible for the management of his/her unique patient based on the
clinical picture presented by the patient and the management options
available locally.
These guidelines were issued in 2015 and will be reviewed in 2019 or
sooner if new evidence becomes available. When it is due for updating,
the Chairman of the CPG or National Advisor of the related specialty
will be informed about it. A discussion will be done on the need for
a revision including the scope of the revised CPG. A multidisciplinary
team will be formed and the latest systematic review methodology used
by MaHTAS will be employed.
, Management of Cervical Cancer (Second Edition)
TABLE OF CONTENTS
No. Title Page
Levels of Evidence & Formulation of Recommendation v
Guidelines Development and Objectives vi
Guidelines Development Group viii
Review Committee ix
External Reviewers x
Algorithm on Management of Cervical Cancer xi
1. INTRODUCTION 1
2. EPIDEMIOLOGY 1
3. RISK FACTORS 2
4. CLINICAL PRESENTATION 2
5. REFERRAL 3
6. DIAGNOSIS 4
7. STAGING 7
8. TREATMENT 11
9. SPECIAL CIRCUMSTANCES 21
10. FOLLOW-UP 27
11. RECURRENT DISEASE 29
12. TREATMENT COMPLICATIONS 32
13. PALLIATIVE CARE 34
14. PSYCHOSEXUAL CARE AND SUPPORT 42
15. IMPLEMENTING THE GUIDELINES 44
16. REFERENCES 46
17.
Appendix 1 Examples of Search Strategy 52
Appendix 2 Clinical Questions 53
Appendix 3 WHO histological classification of tumours 55
of the uterine cervix
, Management of Cervical Cancer (Second Edition)
No. Title Page
Appendix 4 Reporting Proforma for Cervical Cancer 57
Excisional Cervical Biopsies/Hysterectomy
Specimens
Appendix 5 Revised FIGO Cervical Cancer Staging 2009 60
Appendix 6 Modified Delgado Score for Cervical Cancer 61
Appendix 7 ECOG Performance Status 62
Appendix 8 Systemic Therapy of Cancer Protocol 63
Appendix 9 Malaysian Hospice Directory 65
Appendix 10 International Society of Lymphology (ISL) 67
Appendix 11 Distress Thermometer Screening Tool 68
Appendix 12 Medication List 69
List of Abbreviations
Acknowledgement 70
Disclosure Statement 71
Source of Funding 71
