Worldwide, cervical cancer is now the fourth most common female malignancy in both incidence and mortality, following breast, colorectal, and lung cancers, and results in approximately 527 600 new cases and 265 700 deaths annually [1]. It is the second most commonly diagnosed cancer and third most common cause of cancer death among females in low-resource countries. More than 85% of new cases are diagnosed in economically disadvantaged people. Nearly 90% of cervical cancer deaths occur in low-resource regions of the world. The cervix is the lower aspect of the uterus. It is roughly cylindrical in shape, projects through the superior-anterior vaginal wall, and communicates with the vagina through the endocervical canal, which terminates in the external os located at the top of the vagina. Cancer of the cervix may originate from the mucosa of the surface of the cervix or from within the canal. Carcinoma of the uterine cervix grows locally and may extend in continuity to the uterus and paracervical tissues, and pelvic organs. Cervical cancer may spread to regional lymph nodes, and only later metastasize hematogenously to distant structures. Studies on sentinel lymph nodes show that the cervix is drained into the following first echelon nodal stations most commonly: external iliac (43%), obturator (26%) and parametrial (21%), from where they drain to the common iliac nodes. From the common iliac nodes, lymph drainage goes to the para-aortic nodes. The most common sites of distant spread include the para-aortic, mediastinal and supraclavicular nodes, the lungs, liver, and skeleton. FIGO staging is based on clinical examination. The FIGO staging guidelines were most recently updated in 2009 (Table 1) [2]. Stage 0 is no longer included in the FIGO 2009 staging. A thorough pelvic examination is mandatory to provide information for FIGO staging, and this rarely requires anesthesia. When there is doubt as to which stage a particular cancer should be allocated, the earlier stage is mandatory. The following examinations are permitted for the determination of FIGO staging, as indicated by presenting characteristics (see sections below): palpation, inspection, colposcopy, endocervical curettage, hysteroscopy, cystoscopy, proctoscopy, intravenous pyelography, ultrasound of the renal tract, and X-ray examination of the lungs and skeleton. Blood tests should include full blood count, and renal and liver functions. Syphilis and HIV serology need to be considered, based on discussion with the patient about risk factors. The diagnosis of both Stage IA1 and IA2 should be based on microscopic examination of removed tissue, preferably a cone biopsy, which must include the entire lesion. The depth of invasion should not be greater than 5 mm taken from the base of the epithelium, either surface or glandular, from which it originates. The second dimension, the horizontal spread, must not exceed 7 mm. Vascular space involvement, either venous or lymphatic, should not alter the staging, but should be specifically recorded because it may affect treatment decisions. Macroscopically obvious lesions, and those with larger dimensions, should be staged as IB. It is impossible to clinically determine if a cancer of the cervix has extended to the corpus. Extension to the corpus should therefore be disregarded for staging purposes. The diagnosis of Stage IA1 or IA2 disease can only be made on the basis of a cone biopsy with negative margins, or on a trachelectomy or hysterectomy specimen. If the margins of the cone biopsy are positive for cervical intraepithelial neoplasia (CIN) III or invasive cancer, a second cone biopsy should be performed or the patient treated as for Stage IB1 disease [3]. Visible lesions require a biopsy to confirm a diagnosis of cervical carcinoma. A patient with a growth apparently fixed to the pelvic wall by a short and indurated, but not nodular, parametrium should be allotted to Stage IIB. Stage III should be defined for cases where the parametrium is nodular to the pelvic wall or if the growth itself extends to the pelvic wall. The presence of hydronephrosis or non-functioning kidney(s) resulting from obstruction of the ureter(s) by cancer also permits a case to be allotted to Stage III. In cases of grossly invasive disease, a chest X-ray, and evaluation of hydronephrosis (with renal ultrasound, intravenous pyelography, CT, or MRI) are mandatory. The bladder and rectum are evaluated by cystoscopy and sigmoidoscopy only if the patient is clinically symptomatic. Cystoscopy is also recommended in cases of endocervical growth with a barrel-shaped surface and in cases where the growth has extended to the anterior vaginal wall. Suspected bladder or rectal involvement should be confirmed by biopsy and histologic evidence. The presence of bullous edema, as such, should not permit a case to be allotted to Stage IV. Imaging evaluation may be of additional benefit to clinical examination in practice areas where resources allow. Imaging may allow for identification of additional prognostic factors and help direct selection of therapy. MRI provides the best radiologic assessment of primary tumors greater than 10 mm, but is not mandatory [4–8]. Level of Evidence B CT and/or MRI and/or positron emission tomography (PET) may provide information on nodal status or systemic spread, but are not mandatory. Compared with CT and MRI, PET-CT is a more accurate imaging method for detecting nodal metastasis that are greater than 10 mm [5,9–12]. Isolated and unexpected areas of PET enhancement should be further investigated with tissue diagnosis, if possible, to confirm or exclude the presence of distant metastatic disease [11,13,14]. Level of Evidence B Compared with radiologic evaluation, surgical node dissection is more accurate for assessment of para-aortic nodal disease [15,16]. In patients with advanced disease, laparoscopic staging of para-aortic lymph nodes may be considered to allow treatment according to extent of disease [17]. No impact on survival has been demonstrated; however, surgical exclusion of para-aortic lymph node involvement portends a better prognosis than radiographic exclusion alone [18]. Level of Evidence B In a review of 22 articles that evaluated the safety and impact of pre-treatment surgical para-aortic lymph node staging (PALNS), para-aortic lymph node metastases were found in 18% (range, 8%−42%) of patients with cervical cancer Stage IB-IVA [19]. The mean complication rate of PALNS was 9% (range, 4%−24%), the most common complication being lymphocysts. PET-CT appears to be the most accurate imaging method, with false-negative results in 4%−15% of cases. Positive para-aortic nodes have been identified in up to 35% of Stage IIB and 20% of Stage III tumors [19]. Knowing the status of para-aortic nodes may provide prognostic information as well as guide the extent of adjuvant or primary radiation. It is, however, controversial and is not recommended as a routine practice, particularly in resource-restricted environments and in women with advanced disease associated with constitutional symptoms. In cases treated by surgical procedures, the pathologist's findings in the removed tissues can be the basis for accurate statements on the extent of disease. The findings should not be allowed to change the clinical staging, but should be recorded in the manner described for the pathologic staging of disease. The TNM nomenclature is appropriate for this purpose [20]. Unlike FIGO staging criteria, TNM staging accounts for node positivity; however, the FIGO and TNM classifications are otherwise virtually identical in describing the anatomical extent of disease. Clinical staging is essential to select and evaluate therapy, while the pathological stage provides the most precise data from which to estimate prognosis and calculate end results. Infrequently, hysterectomy may be carried out in the presence of unsuspected invasive cervical carcinoma. Such cases cannot be clinically staged or included in therapeutic statistics, but it is desirable that they be reported separately. If considered appropriate, some of these patients may be offered repeat laparotomy with full parametrectomy and pelvic lymphadenectomy to allow potentially curative surgery and/or determine the need for adjuvant chemoradiation [21]. Staging is determined at the time of the primary diagnosis and cannot be altered, even at recurrence. Only if the rules for clinical staging are strictly observed is it possible to compare results among clinics and by differing modes of therapy. Squamous cell carcinoma (keratinizing; non-keratinizing; verrucous). Endometrioid adenocarcinoma. Clear cell adenocarcinoma. Adenosquamous carcinoma. Adenoid cystic carcinoma. Small cell carcinoma. Undifferentiated carcinoma. GX: Grade cannot be assessed. G1: Well differentiated. G2: Moderately differentiated. G3: Poorly or undifferentiated. When surgery is the primary treatment, the histologic findings permit the case to have pathologic staging, as described above. In this situation, the TNM nomenclature may be used. Primary prevention of cervical cancer through HPV vaccination of girls, and secondary prevention through the detection of cervical cancer precursors by various screening methods and their appropriate treatment, are both known to be effective preventive measures. Details on cervical cancer screening can be accessed via the FIGO website (www.figo.org). Conization is the treatment of choice for this stage. If the patient has completed childbearing, hysterectomy (abdominal, vaginal, or laparoscopic) may be considered [22]. Follow-up with Pap smears every 3 months for 2 years, and then every 6 months for a further 3 years should be performed. If follow-up is normal at 5 years, the screening schedule may be completed according to the recommendations in each country [23,24]. Level of Evidence C Since lymph nodes may be involved in this stage, lymphadenectomy is necessary [25,26]. The recommended treatment is type 2 radical hysterectomy (ligation of the uterine artery where it crosses the ureter, although a vaginal cuff is not necessary) with pelvic lymphadenectomy. If fertility is desired, options are: (1) cervical conization with extraperitoneal or laparoscopic pelvic lymphadenectomy; or (2) radical abdominal, vaginal, or endoscopic trachelectomy with pelvic lymphadenectomy performed according to the surgical approach [27,28]. Follow-up with Pap smears every 3 months for 2 years, and then every 6 months for a further 3 years should be performed. If follow-up is normal at 5 years, the screening schedule may be completed according to the recommendations in each country [23,24]. Level of Evidence C Concurrent platinum-based chemoradiation is the most indicated treatment for this stage although neoadjuvant chemotherapy may play a role in selected settings [29]. The treatment approach should be decided based on the availability of resources, and tumor- and patient-related factors. Surgical treatment may be indicated in Stage IB1–IIA1 disease: modified radical or radical (abdominal or endoscopic) hysterectomy with pelvic lymphadenectomy [30–32]. Level of Evidence B Primary pelvic exenteration may be considered for Stage IVA disease without extension to the pelvic sidewall or extra-pelvic disease [33–46]. Level of Evidence C Identification of sentinel lymph nodes can be performed with dual labeling using blue dye and radiocolloid [47–49]. These procedures may be considered in early stage cervical cancer, Stage IA and IB1 [50–52]. If lymphovascular space invasion is present, pelvic lymphadenectomy needs to be considered. Level of Evidence C Sentinel lymph node assessment of pelvic lymph nodes should not be utilized in advanced disease [53]. Stages IA2–IB1 with tumor size of less than 2 cm, cervical stromal invasion of less than 50%, and node negative on MR/CT imaging have been considered as low risk. Simple hysterectomy or trachelectomy, with either pelvic lymphadenectomy or sentinel lymph node assessment, have been considered as adequate surgical treatment for low-risk cases [54,55]. Level of Evidence D The risk of recurrence after radical surgery is increased in the presence of positive nodes, positive parametria, or positive surgical margins. Adjuvant concurrent chemoradiation (cisplatin with or without 5-fluorouracil) improves overall survival, progression-free survival, and both local and distant recurrences compared with pelvic irradiation alone in such patients [42]. Level of Evidence B Risk of pelvic recurrence is also increased in those with uninvolved nodes but with primary associated risk factors: tumor size greater than 4 cm, capillary-like space (CLS) involvement, and outer one-third invasion of the cervical stroma [43,44]. Adjuvant whole pelvic chemo-irradiation reduces the local failure rate and improves progression-free survival compared with patients treated with surgery alone [43]. Level of Evidence B Adjuvant radiation therapy with and without chemotherapy may be particularly beneficial for patients with adenocarcinoma or adenosquamous histology, given the relatively higher rates of distant failure [42,43]. Level of Evidence C Patients with positive common iliac or para-aortic nodes may be treated by extended field radiation [56,57], with or without chemotherapy. Level of Evidence C Intensity modulated radiation therapy has been explored in the postoperative setting. A prospective multi-institutional study has shown acceptable toxicities with this approach and a randomized trial (TIME-C) is underway comparing intensity-modulated radiation therapy (IMRT) with standard field-based radiation therapy in postoperative cervical and endometrial cancer [58,59]. Although there is currently insufficient evidence at the present time to recommend IMRT as a standard of care, many centers have shifted to using this technique in postoperative cervical and endometrial cancer treatment. The theoretical rationale for the use of neoadjuvant chemotherapy (NACT) includes the induction of tumor shrinkage to facilitate radical excision, and a possible improvement in outcomes over surgery alone. There is also a possibility of NACT sterilizing nodes and parametria, thereby reducing risk factors for adjuvant therapy after surgery; however, the efficacy of neoadjuvant therapy in this situation is not known. A meta-analysis of randomized trials of neoadjuvant platinum-based chemotherapy prior to definitive surgery shows that patients treated with NACT have better survival outcomes than those treated with primary radiation alone, given at a relatively low dose [60]. No randomized data compare the results of NACT followed by surgery with concurrent chemoradiation. The European Organization for Research and Treatment of Cancer is currently conducting a Phase 3 study comparing NACT and surgery with definitive chemoradiation in patients with FIGO Stages IB2, IIA2, or IIB cervical cancers. NACT followed by surgery is commonly used in some countries, but its role is uncertain as a review of available literature suggests no benefit of NACT-surgery over upfront surgery plus adjuvant therapy [61]. Optimal pathologic response, defined as persistent residual disease with less than 3 mm of stromal invasion in the surgical specimen, is the strongest predictor of freedom from local recurrence for patients treated with NACT and surgery [62]. A chemotherapy regimen of paclitaxel, ifosfamide, and cisplatin has higher response rates than ifosfamide and cisplatin for Stage IB2, although not for Stage IIB [63]. A statistically significant effect on overall survival was not found, although this study was insufficiently powered for overall survival outcomes [63]. Surgery after NACT should consist of radical hysterectomy and pelvic lymphadenectomy. Many patients randomized to NACT-surgery either were unable to proceed with radical surgery after chemotherapy (40%) or required additional adjuvant therapy after surgery (26%) [64]. NACT surgery should be carefully considered in patients with larger tumors or adenocarcinoma histology owing to lower response rates. Stage IIB and higher stages should be preferentially managed with definitive chemoradiation therapy. NACT obscures the pathologic findings at the time of surgery, complicating evaluation of indications for adjuvant radiotherapy with or without adjuvant chemotherapy. Indications for adjuvant therapy after primary surgery [42,43] are often applied in the setting of NACT surgery. Level of Evidence C Chemoradiotherapy is the standard of care for patients with IB2, IIA2, IIB, IIIA, IIIB, and IVA disease. Standard concurrent chemoradiation therapy includes external radiation and intracavitary brachytherapy [65,66]. Level of Evidence A Standard radiation treatment of cervical carcinoma is external pelvic irradiation plus brachytherapy. Suggested doses of external beam radiation are 45–50 Gy in 180–200 cGy per fraction. Standard radiation planning techniques are outlined in Table 2. A full description of radiation used in cervical cancer treatment is included in the radiation therapy chapter included in the FIGO Cancer Report 2015 (this Supplement) [67]. Timely completion of radiotherapy is essential for optimal outcomes. In retrospective trial data, patients with radiotherapy treatment times of greater than 9–10 weeks had significantly higher rates of pelvic failure, compared with women completing treatment in less than 6–7 weeks [68,69]. It is recommended that all external beam radiotherapy and brachytherapy be completed within 56 days. Concurrent chemoradiation confers a significant overall survival benefit compared with the same radiation alone, with a meta-analysis of 13 trials showing a five-year survival advantage of 6% (Hazard Ratio: 0.81) [29]. Concurrent chemoradiotherapy also reduced local and distant recurrence, and improved disease-free survival. Level of Evidence A A once-weekly infusion of cisplatin (40 mg/m2 weekly with appropriate hydration) for 5–6 cycles, is a commonly used concurrent chemotherapy regimen, and is equally effective and less toxic than combined cisplatin and 5-fluorouracil in a 21-day schedule during external beam therapy [65,70]. For patients who are unable to receive platinum chemotherapy, 5–fluorouracil-based regimens are an acceptable alternative [29,71]. Data on the toxicity associated with concurrent chemotherapy and extended field irradiation are limited [56,57]. Although randomized studies of chemoradiotherapy included patients with Stage IB2 and above, given the magnitude of the survival benefit, concurrent chemotherapy with a platinum-based regimen is often recommended for any patient considered suitable for radical radiotherapy, if the patient is fit enough. Additional adjuvant chemotherapy after concurrent chemoradiotherapy is being explored in an international randomized controlled trial (OUTBACK Trial) [72]. A single randomized study suggests possible benefit in progression-free and overall survival with additional chemotherapy, but with more severe toxicity [73]. At present there is insufficient evidence to recommend additional adjuvant chemotherapy as a standard of care. Where available, brachytherapy constitutes an essential component of radical radiotherapy or chemoradiotherapy. However, bulky tumors may be curable with external beam radiation alone if brachytherapy and/or chemotherapeutic agents are not readily available. Recognized prognostic factors for probability of cure include lower stage, squamous cell histology, and good performance status. In situations where brachytherapy is not available, an external beam boost is a reasonable option to achieve local control. A total radiation dose of 54–70 Gy can provide local control rates of 52%, with a median time to recurrence of 2.3 years [74]. A systematic review of 17 retrospective trials for follow-up of women after treatment for cervical cancer found the median time to recurrence after treatment ranged from 7–36 months after primary treatment [75]. An optimal post-treatment follow-up strategy has not been established and clinical practice is variable. Common recommendations include educating patients about potential symptoms, history taking, and clinical examination at routine follow-up intervals to detect treatment complications and psychosexual morbidity, as well as to assess for recurrent disease. Level of Evidence D Commonly used tests include chest X-ray, ultrasound, CT scans, and intravenous pyelography. As isolated central recurrences are potentially curable, closer clinical follow-up in the 2–3 years after treatment may be important. Routine imaging is not indicated. Special circumstances, such as involved high pelvic lymph nodes, may justify interval imaging of the abdomen to assess for potentially curable progression of disease. In the systematic review, asymptomatic recurrent disease was detected using physical exam (29%−71%), chest X-ray (20%−47%), CT (0%−34%), and vaginal vault cytology (0%−17%) [75]. Frequent vaginal vault cytology does not significantly improve the detection of early disease recurrence. Patients should return to annual population-based screening after 5 years of disease-free survival [75]. Presentation with distant metastatic disease is rare, reported in about 2% of cases [76]. There has been no randomized comparison of chemotherapy to best supportive care for Stage IVB cervical carcinoma. Few studies have evaluated the impact of systemic therapy on palliative and quality-of-life endpoints. There is some evidence that concurrent chemoradiation may have better response than systemic chemotherapy [77]. Overall and disease-free survivals of 69% and 57% respectively have been reported in patients with positive para-aortic and supraclavicular lymph nodes [78]. Level of evidence D A management plan should consider that the median duration of survival with distant metastatic disease is approximately 7 months. Despite limited response rates, cisplatin has been the standard chemotherapy used in the setting of distant metastatic disease [79,80]. Given low response rates to cisplatin alone after concurrent chemoradiation, recent evidence supports the use of platinum doublets over cisplatin alone, although with very modest benefits in response rates. Cisplatin may be combined with taxanes, topotecan, 5-fluorouracil, gemcitabine, or vinorelbine [80]. Carboplatin-paclitaxel combination has also been successful in these cases. In a recent study, the addition of bevacizumab in a dose of 15 mg per kg body weight to chemotherapy with a combination of either cisplatin-paclitaxel or topotecan-paclitaxel was evaluated [81]. Bevacizumab increased the overall survival (17.0 months vs 13.3 months; hazard ratio for death, 0.71; 98% CI, 0.54−0.95; P = 0.004 in a one-sided test) and higher response rates (48% vs 36%, P = 0.008). Bevacizumab, as compared with chemotherapy alone, was associated with an increased incidence of hypertension of grade 2 or higher (25% vs 2%), thromboembolic events of grade 3 or higher (8% vs 1%), and gastrointestinal fistulas of grade 3 or higher (3% vs 0%). Palliative systemic therapy may be considered for patients with an ECOG (Eastern Cooperative Oncology Group) performance status of 0–2 (Table 3). Discussion of participation in clinical trials should be considered, particularly for patients who have relapsed within 12 months [82]. Local treatment with radiation therapy is indicated to sites of symptomatic involvement in patients with metastatic disease. Alleviation of symptoms with palliative radiation can often be achieved for pain arising from enlarged para-aortic or supraclavicular nodes, skeletal metastases [83], and symptoms associated with cerebral metastases. In view of the short life expectancy of patients with metastatic cervical cancer, palliative radiotherapy should be given via larger fractions over shorter periods of time than conventional radical courses of treatment. There are no data to endorse specific dose/fractionation schemes for soft tissue metastases; commonly used schedules include large single fractions, 20 Gy in five fractions, and 30 Gy in 10 fractions. Patients with incurable cervical cancer may develop a range of challenging symptoms and should be managed on an individual basis. Common problems associated with advanced cervical cancer can include: pain, ureteric obstruction causing renal failure, hemorrhage, malodorous discharge, lymphedema, and fistulas. Patients may benefit from a wide range of clinical services to manage these symptoms, as well as psychosocial care and support for patients and their families. Access to oral morphine is improving within low-resource countries and is an important aspect of palliative care. Recurrences may be pelvic, para-aortic, distant, or a combination. The risk of both pelvic and distant failure increases with the bulk of disease [84,85]. The majority of recurrences occur within 3 years of diagnosis, and the prognosis is poor, with most patients dying as a result of uncontrolled disease [86]. Treatment decisions should be based on the performance status of the patient, the site of recurrence and/or metastases, the extent of metastatic disease, and prior treatment [87]. For patients with extensive local disease or distant metastatic disease, the intent of therapy is palliative, and best supportive care is generally the recommended management. For patients with good performance status and limited metastatic disease, a trial of platinum doublet systemic therapy may be justified, understanding the limited benefits with respect to response rate and progression-free survival [79,81]. Local recurrence that is not salvageable with surgery or radiotherapy has a very poor response to systemic chemotherapy. Some patients with locally recurrent disease after definitive therapy (surgery or radiotherapy) are potentially curable. Favorable prognostic factors include an isolated central pelvic recurrence with no sidewall disease, a long disease-free interval, and size of the recurrence less than 3 cm in diameter [36,88]. Relapse in the pelvis following primary surgery may be treated by either radical chemoradiation or pelvic exenteration. Radical irradiation with or without concurrent chemotherapy) may result in five-year disease-free survival rates of 45%–74% with isolated pelvic failure after primary surgery [89,90]. The extent of recurrent disease and involvement of pelvic lymph nodes are prognostic factors for survival [91]. Level of Evidence C The radiation dose and volume should be tailored to the extent of recurrent disease; 45–50 Gy in 180 cGy fractions should be delivered to areas likely to be involved with microscopic disease, and a boost dose of up to 64–66 Gy to the gross tumor volume using field reductions. Concurrent chemotherapy with either cisplatin and/or 5-fluorouracil may improve outcome [92]. Pelvic exenteration may be a feasible treatment option in selected patients who have recurrence after radiation. Suitable candidates for exenteration after previous surgery or pelvic radiation are patients without evidence of intra-peritoneal or extra pelvic spread, and who have a tumor-free space along the pelvic sidewall [33–37]. Level of Evidence C Owing to the morbidity of exenteration, its use is confined to those with curative potential, and requires careful patient selection regarding the associated physical and psychological demands. Confirmation of recurrence with a pathologic specimen obtained by biopsy is essential prior to proceeding with exenteration. A PET/CT is the most sensitive non-invasive test to determine any sites of distant disease, and if possible, should be performed prior to exenteration [13,93–100]. Patient assessment and counseling regarding the implications and ability to manage stoma and ostomy sites must be addressed prior to surgery [101]. Careful selection of patients may yield a five-year survival with pelvic exenteration in the order of 30%–60% [33,34,36], and an operative mortality of less than 10% [102]. After the pelvis, para-aortic lymph nodes are the next most common site of recurrent disease. Possible long-term survival with radical-intent radiotherapy or chemoradiotherapy can be achieved in approximately 30% of patients with isolated para-aortic nodal recurrence [103]. Patients with asymptomatic, low volume recurrences that occur greater than 24 months from initial treatment have better outcomes [103]. Level of Evidence C Invasive cervical cancer may be found during the pathological evaluation of the specimen of a simple hysterectomy for an apparently benign condition. Overall survival is lower in cases of tumor cut-through leaving residual disease [104]. When this circumstance happens, a PET/CT scan if available, or a pelvic and abdominal CT or MRI scan and chest imaging should be performed, to assess the extent of disease. The treatment proposal should be tailored based on the histologic and the radiologic findings. Pelvic radiation (with or without concurrent chemotherapy) and vaginal brachytherapy should be considered [104–106]. Level of Evidence C A multidisciplinary decision-making team with the involvement of an obstetrician, neonatologist, psychologist, and spiritual advisor is recommended to make a tailored individual therapeutic proposal. All plans should be discussed with the patient (and preferably her partner), and her wishes must be respected. In general, the management of cervical cancer in pregnant women follows the same principles as in non-pregnant women. Cases before 16–20 weeks are treated without delay with either surgery or chemoradiation. From the second trimester onward, surgery and chemotherapy can be used in selected cases while preserving the pregnancy [107]. Level of Evidence C If the diagnosis is made after 20 weeks, treatment delay appears to be an option for Stages IA2 and IB1, with no apparent impairment of prognosis compared with non-pregnant controls [108–110]. Treatment consisting of classical cesarean delivery and radical hysterectomy is often undertaken when a balance is reached between competing maternal and fetal health risks, usually not later than 34 weeks of pregnancy. Level of Evidence C For more advanced disease, it is not known whether treatment delay will affect survival. If a treatment delay is planned in women with locally advanced disease, neoadjuvant chemotherapy may be considered in an attempt to prevent disease progression [111,112]. Dr Bermudez has received a grant from Pfizer for Consulting Services. Dr Bhatla has received research funding through her institute from MSD, GlaxoSmithKline, and Digene/Qiagen Inc. Dr Leung has no conflicts of interest. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
