The evidence-based recommendations described below outline the standard follow-up procedures for cervical cancer surveillance, and are intended to assist you in providing optimal cancer follow-up care for your patient; these recommendations are not intended to be a substitute for clinical judgement.
In general, follow-up is recommended every 3-6 months for the first 2-3 years, then annually. Please review the detailed progress notes for your patient’s stage and the exact schedule recommended for your patient. Follow-up activities include:
Patients with an abnormal cytology result should be referred for colposcopy. Please follow the TOP guideline recommendations for cervical cancer screening and referral.
Symptomatic patients should undergo appropriate tests to rule out a recurrence.
Please be aware of these potential symptoms of cervical cancer recurrence:
Patients who display symptoms suggestive of recurrence should undergo biopsy and/or imaging.
Patients with confirmed recurrence should be referred back to their original Cancer Centre/oncologist. Referrals can be faxed to the Gynecologic Oncology triage coordinator at: 403-521-3245 (Tom Baker Cancer Centre/Southern Alberta) or 780-432-8681 (Cross Cancer Institute/Northern Alberta). If you are unable to reach the triage coordinator, search "cancer" in the Alberta Referral Directory for the most up-to-date information and instructions for referral.
Following treatment for cervical cancer, your patient may present with some of the complications outlined below. Continue to monitor and address concerns related to cancer therapy.
| Complication | Treatment-Related Causes | Actions |
|---|---|---|
| Bladder dysfunction |
|
Symptoms such as urinary incontinence, retention, frequency, urinary tract infection, and hematuria should be treated as appropriate. Referral to urology for ongoing management can be considered. |
| Chronic GI symptoms |
|
Symptoms such as chronic diarrhea, fecal leakage, and pain should be treated as appropriate. Referral to GI for ongoing management can be considered. |
| Fatigue |
|
Fatigue should start to improve within months of treatment completion. Persistent or recurrent fatigue warrants further work-up to rule out other potential causes. |
| Lymphedema |
|
Early symptoms include leg heaviness or discomfort and may be present with/without overt swelling. Referral to local rehabilitation services (e.g. physiotherapy) or lymphedema clinic can be made. More information can be found in the lymphedema resource. |
| Menopausal symptoms |
|
Some patients will experience new symptoms of menopause after treatment. During the active follow-up phase, patients manifesting symptoms of menopause such as vaginal dryness and hot flashes will be monitored as applicable by the oncology treatment team. |
| Deep venous thrombosis (DVT) or pulmonary embolus (PE) |
|
Confirm with ultrasound of affected extremity (DVT) or CT for PE. Stop Tamoxifen and commence anticoagulation. Consult medical oncologist for direction. |
| Psychosocial distress |
|
Increasing helplessness /hopelessness, distress, anxiety or depression may be present. Patients experiencing these symptoms should be encouraged to inform their oncology treatment team for appropriate psychosocial referral. More information about fear of recurrence is found in the FCR resource. |
| Sexual dysfunction |
|
Vaginal shortening, pain, decreased lubrication, and decreased arousal may occur. See below for more information. |
Sexual Dysfunction
Treatment for cervical cancer can have significant impacts on sexual function and health. The Oncology and Sexuality, Intimacy, and Survivorship (OASIS) program assists patients to manage physical and emotional concerns.
More information about sexual dysfunction and the OASIS program is found in the Cervical Cancer Transfer of Care Physician Letter.
Menopause
Some patients treated for cervical cancer may experience early menopause as a result. Patients are encouraged to report concerns regarding managing menopausal symptoms with their treatment team.
HPV Vaccine
Patients who have had cervical cancer do not need to get the HPV vaccine. For more information, please visit screeningforlife.ca.
Note: The information on this page was adapted from the AHS Guideline Resource Unit's Cancer of the Uterine Cervix guideline, and the accompanying Cervical Cancer Transfer of Care Physician Letter. Also available is the Cervical Cancer Transfer of Care Patient Letter.
