Een nationale praktijkrichtlijn voor de aanpak van cervixkanker
Authors: Vergote Ignace , Vlayen Joan , Robays Jo , Stordeur Sabine , Stemkens Daphne , Smit Yolba , Bourgain Claire , De Greve Jacques , Kridelka Frédéric , Scalliet Pierre , Simon Philippe , Stroobandts Sigrid , Van Dam Peter , Van Limbergen Erik , Villeirs Geert 
Published: January 2025

1. INTRODUCTION 6 -- 1.1. SCOPE 6 -- 1.2. EPIDEMIOLOGY 6 -- 2. METHODOLOGY 6 -- 2.1. GENERAL APPROACH 6 -- 2.2. CLINICAL QUESTIONS 6 -- 2.3. INTERNATIONAL COLLABORATION 7 -- 2.4. LITERATURE SEARCHES 7 -- 2.4.1. Search strategy 7 -- 2.4.2. Quality appraisal 8 -- 2.5. DATA EXTRACTION AND SUMMARY 9 -- 2.6. FORMULATION OF RECOMMENDATIONS 9 -- 2.7. EXTERNAL EXPERT MEETING 9 -- 3. FINAL RECOMMENDATIONS 10 -- 3.1. TREATMENT OF HIGH-GRADE CIN 10 -- 3.1.1. Treatment of CIN2/3 10 -- 3.1.2. Follow up of CIN2/3 13 -- 3.1.3. Role of HPV testing in the follow up after treatment 13 -- 3.1.4. Conclusions 13 -- 3.1.5. Recommendations 14 -- 3.2. DIAGNOSIS AND STAGING OF INVASIVE CERVICAL CANCER 15 -- 3.2.1. FIGO staging 15 -- 3.2.2. Tumour characteristics 16 -- 3.2.3. Lymph node metastases 19 -- 3.2.4. Surgical lymph node staging 24 -- 3.2.5. Distant metastases 25 -- 3.2.6. Global staging accuracy 25 -- 3.2.7. Tumour markers 26 -- 3.2.8. Histopathology 26 -- 3.2.9. Recommendations 27 -- 3.3. TREATMENT OF FIGO STAGE IA CERVICAL CANCER 27 -- 3.3.1. Recommendations 29 -- 3.4. TREATMENT OF NON-METASTATIC CERVICAL CANCER 29 -- 3.4.1. Stage IB1 and IIA1 29 -- 3.4.2. Recommendations 31 -- 3.4.3. Stage IB2, IIA2, IIB, IIIA, IIIB and IVA 31 -- 3.5. MANAGEMENT OF METASTATIC AND RECURRENT DISEASE 36 -- 3.5.1. Surgery 36 -- 3.5.2. Chemotherapy for recurrent and stage IVB 37 -- 3.6. FERTILITY-SPARING TREATMENT 39 -- 3.6.1. Conization 39 -- 3.6.2. Radical vaginal trachelectomy 39 -- 3.6.3. Abdominal radical trachelectomy 40 -- 3.6.4. Fertility-sparing treatment according to tumour size 40 -- 3.6.5. Experimental protocols 41 -- 3.7. TREATMENT OF INVASIVE CANCER DURING PREGNANCY 42 -- 3.8. SEXUAL MORBIDITY AFTER TREATMENT FOR CERVICAL CANCER 43 -- 3.9. FOLLOW-UP AFTER TREATMENT FOR CERVICAL CANCER 45 -- 3.9.1. Follow-up after primary treatment 45 -- 3.9.2. PET for the detection of (local or distant) cervical carcinoma recurrence 45 -- 3.9.3. SCCA for the detection of cervical carcinoma recurrence 46 -- 3.9.4. Vaginal smear for the detection of cervical carcinoma recurrence 47 -- 3.9.5. Recommendations 47 -- 4. APPENDICES 48 -- 4.1. APPENDIX 1: GRADE SYSTEM 48 -- 4.1.1. Levels of evidence 190 48 -- 4.1.2. Down- or upgrading the evidence 191 49 -- 4.1.3. Strength of recommendations 50 -- 4.2. APPENDIX 2: SEARCH STRATEGY 50 -- 4.2.1. OVID Medline 50 -- 4.2.2. PubMed 54 -- 4.2.3. Embase 57 -- 4.3. APPENDIX 3: QUALITY APPRAISAL OF GUIDELINES 67 -- 4.4. APPENDIX 4: QUALITY APPRAISAL CHECKLISTS COCANCPG 70 -- 4.4.1. Systematic reviews 70 -- 4.4.2. Randomised controlled trials 70 -- 4.4.3. Cohort studies 70 -- 4.4.4. Case-control studies 70 -- 4.4.5. Diagnostic accuracy studies 71 -- 4.5. APPENDIX 5: EXTERNAL EXPERT REVIEW 72 -- 4.6. APPENDIX 6: EVIDENCE TABLES 77 -- 4.6.1. Guidelines 77 -- 4.6.2. Additional evidence 91 -- 5. REFERENCES 200