More than 100,000 cases of gynecologic cancer are diagnosed every year in the USA. Women who survived primary treatment for gynecologic cancer are estimated at more than 8 million and are likely to increase at about 10 million in the coming decade. It is obvious that there is a growing population group that needs a proper care by a team of health professionals. Post-treatment monitoring of gynecologic cancer survivors ideally has to achieve three major objectives: 1) tο diagnose, as early as possible, the recurrence of the disease, either local or distant; 2) to improve the quality of life of cancer survivors; and 3) to achieve all the above goals with a reasonable cost for the Health Providing Systems. In this report, the authors refer to post-treatment monitoring of women with all kinds of gynecologic cancers (endometrial, ovarian, vulvar, vaginal, and cervical) and the follow up of women after primary treatment for breast cancer.
TopIntroduction/Epidemiology
More than 100,000 cases of gynecologic cancer are diagnosed every year in USA (Faubion et al., 2015). Women that survived primary treatment for gynecologic cancer are estimated to more than 8 million (Miller et al., 2016) and are likely to increase at about 10 million in the coming decade (Table 1). Breast cancer, together with lung cancer, are the most common types of cancer in women population in the US (American Cancer Society 2017-2018).
It is obvious that there is a constantly growing population group that needs a proper care by a team of health professionals.
Post treatment monitoring of gynecologic cancer survivors ideally has to achieve three major objectives: 1) tο diagnose, as early as possible, the recurrence of the disease, either local or distant, 2) to improve the quality of life of cancer survivors, and 3) to achieve all the above goals with a reasonable cost for the Health Providing Systems.
In this report, we will refer to post-treatment monitoring of all kinds of gynecologic cancers including endometrial, ovarian, vulvar, vaginal and cervical. The type of tests, imaging modalities (ultrasound scans, CT scans, MRI scans) and time intervals are mostly based on the guidelines published by the Society of Gynecologic Oncology in 2017 (Salani et al., 2017). The guidelines emphasize, though, the importance of clinical examination in the early diagnosis of disease recurrence (Salani et al., 2017).
There is also a chapter regarding the monitoring of women after treatment for breast cancer, although it may be found as a separate chapter in other textbooks.
Cancer of the Cervix of the Uterus
Almost 70-80% of recurrence cases will be apparent in the first 2 -3 years after primary treatment (Elit et al., 2010). Symptoms that indicate the possibility of disease recurrence include vaginal discharge, vaginal bleeding, pelvic pain, cough and weight loss (Salani et al., 2017).Patients should be informed to seek medical assistance if they experience such symptoms regardless the monitoring protocol.
The cornerstone of surveillance is physical examination of the pelvis and the vaginal vault, together with the rest of the abdomen and thorax. Most cases of recurrence will be diagnosed by clinical examination, even though women are asymptomatic. The use of Pap test should be considered annually. The tactical use of cytology with or without colposcopy should be preserved for women treated with radiation or in cases of radical trachelectomy (Salani et al., 2017). The use of HPV DNA test has not been studied yet. Routine use of imagining modalities (CT or MRI scan) is not indicated unless there is clinical suspicion or symptoms of disease recurrence (Table 2) .
Cancer of the Vulva
Vulvar cancer represents 4% of gynecological cancers attributed to HPV infection from 30 to 69% of cases. More than 50% of recurrence will appear locally within the first year of treatment although there are reports of recurrence after five years from the initial treatment (Salani et al., 2017). Thorough clinical examination of the vulva and groin is the cornerstone of surveillance (Table 2).
Cancer of the Vagina
Primary cancer of the vagina is extremely rare and in most cases HPV infection is the cause. SGO suggests the same algorithm of surveillance with the cases of vulvar and cervical cancer (Salani et al., 2017), (Table 2).