Cervical Cancer

In carefully selected patients with very early-stage disease, fertility-sparing and less invasive procedures may be considered:

• Conization: removal of a cone-shaped portion of the cervix containing the lesion, which may be sufficient for diagnosis and treatment in selected cases
• Trachelectomy: removal of the cervix while preserving the uterine body, offering the possibility of maintaining fertility in appropriately selected patients

For patients with early-stage cervical cancer, surgery is generally the primary treatment option. Depending on the characteristics and extent of the disease, surgical management may include:

• Radical hysterectomy, involving removal of the uterus, surrounding supporting tissues (parametrium and paracervix), and, in selected cases, the ovaries
• Sentinel lymph node biopsy, performed alone or in combination with pelvic lymphadenectomy (removal of pelvic lymph nodes) to assess potential lymph node involvement

Based on the final pathological findings and the presence of specific risk factors, adjuvant radiotherapy or chemoradiotherapy may be recommended after surgery to reduce the risk of recurrence.

Evidence from the landmark Laparoscopic Approach to Cervical Cancer (LACC) trial has shown that, for most patients with early-stage cervical cancer, the preferred surgical approach is open surgery (laparotomy) rather than minimally invasive surgery. Minimally invasive approaches may still be considered in carefully selected cases and according to individual clinical circumstances.

For patients with locally advanced cervical cancer, the standard treatment is a combined approach that integrates radiotherapy and chemotherapy.

Treatment typically includes:

• External beam radiotherapy (EBRT), directed at the tumor and surrounding areas at risk of disease spread
• Concurrent cisplatin-based chemotherapy, administered during radiotherapy to enhance its effectiveness
• Brachytherapy, an internal radiation therapy technique in which specialized applicators are placed within the uterus and cervix to deliver high-dose radiation directly to the tumor while minimizing exposure to surrounding healthy tissues

This multimodal approach aims to maximize local disease control and improve long-term outcomes.

Immunotherapy represents an important therapeutic option in selected patients with cervical cancer, particularly because the PD-L1 protein, a target of several immunotherapeutic agents, is expressed in more than 90% of cases.

The most commonly used immunotherapy drugs include:

• Pembrolizumab
• Atezolizumab
• Nivolumab
• Ipilimumab in combination with Nivolumab

These treatments work by enhancing the body’s immune response against cancer cells, helping the immune system recognize and eliminate tumor tissue more effectively.

Immunotherapy has expanded treatment opportunities, particularly for patients with advanced, recurrent, or metastatic cervical cancer, and may be used alone or in combination with other therapies depending on the clinical setting and tumor characteristics.

Cancer patients often require ongoing support throughout their care journey. When new symptoms arise, whether related to the disease itself or to treatment-related side effects, timely access to specialist evaluation is essential.

For this reason, the Candiolo Cancer Institute provides a dedicated support service operating Monday through Friday, from 8:00 a.m. to 5:00 p.m. Patients who require an urgent consultation can contact the Oncology Day Hospital Secretariat at +39 011 993 3775. Following the request, the patient is promptly contacted by the appropriate specialist to ensure rapid assessment and management of the issue.

This service is designed to provide continuity of care, address treatment-related concerns promptly, and support patients throughout every stage of their oncological pathway.

Cancer patients often have complex needs that extend beyond the treatment of the disease itself and require comprehensive, multidisciplinary support throughout their care journey.

At the Candiolo Cancer Institute, patients who need additional support have access to specialists from a range of disciplines, ensuring integrated care tailored to their individual needs. Services may include nutritional counseling, physical rehabilitation, pain management, palliative care, and support for the treatment of other conditions associated with cancer and its therapies.

The goal is to preserve quality of life, manage symptoms effectively, and provide personalized support at every stage of the disease pathway.

A cancer diagnosis affects not only physical health but also emotional and psychological well-being. The experience of cancer can be profoundly challenging and may give rise to feelings of anxiety, fear, anger, uncertainty, or depression.

At the Candiolo Cancer Institute, psychological care is an integral part of the treatment pathway. Alongside state-of-the-art therapies, patients have access to qualified psycho-oncology professionals who provide support throughout every stage of the disease, helping them cope with treatment, manage emotional distress, and navigate the physical and psychological challenges of recovery.

Patients may also participate in psychological support groups, which offer the opportunity to share experiences, exchange perspectives, and connect with others who are facing or have faced similar challenges. These group settings can provide valuable emotional support and help reduce feelings of isolation during the cancer journey.

To ensure timely support and provide rapid answers to questions or concerns that may arise during treatment, the Candiolo Cancer Institute offers a dedicated assistance service for all patients.

From Monday to Friday, between 8:00 a.m. and 5:00 p.m., patients can contact the Oncology Day Hospital Secretariat at +39 011 993 3775 to request an urgent consultation.

Following the request, the patient will be promptly contacted by the appropriate specialist, ensuring rapid clinical assessment, clear information, and timely support whenever needed.

The Social Work Service at the Candiolo Cancer Institute provides information, guidance, and support to patients and their families regarding access to community services and the welfare and social security benefits available under current legislation.

During dedicated consultations, social workers assist with matters such as disability recognition, access to aids and prosthetic devices, employment-related benefits and leave, and other social support services.

The service is available on Wednesdays and Fridays from 9:00 a.m. to 1:00 p.m. and can be contacted at +39 011 993 3059.

Following completion of treatment, regular follow-up is essential to monitor recovery, identify any signs of recurrence, and address treatment-related side effects.

According to the recommendations of the European Society of Gynaecological Oncology (ESGO), follow-up generally includes:

• A gynecological examination every 3 to 6 months during the first two years after treatment, followed by every 6 months for the subsequent three years
• An annual Pap test
• Imaging studies, such as ultrasound, CT, or MRI, and blood tests when clinically indicated, according to a schedule determined by the treating physician

Follow-up plans may be tailored to the individual patient based on disease characteristics, treatment received, and specific clinical needs.

Thanks to the large number of cancer cases treated each year, the Candiolo Cancer Institute is a national reference center for the care of this disease. This extensive experience allows us to manage even the most complex cases, always using a personalized approach, tailored to the clinical and individual profile of each patient.

Establishing a treatment plan always begins with an accurate and timely diagnosis. Patients have access to state-of-the-art imaging technologies, such as ultrasound, contrast-enhanced CT, MRI, and cholangio-RM, which are critical for accurately assessing the extent of the tumor.

Advanced laboratory tests, including molecular analyses, are also available to help define biological features of the disease and guide treatment choices.

When appropriate, liver surgeries are performed using minimally invasive, laparoscopic or robotic techniques. These approaches involve the use of camera-equipped instruments introduced into the abdomen through small incisions, thus reducing surgical trauma. Benefits to the patient include shorter hospital stay times, faster recovery, and lower risk of complications compared with traditional open surgery.

As an IRCCS (Scientific Institute for Research, Hospitalization, and Healthcare), the Candiolo Cancer Institute combines clinical care with a strong focues on scientific research. Patients can be considered for participation in active clinical trials, offering access to innovative therapies not yet available in standard practice. This integration of care and research is a distinctive strength that translates into tangible benefits for patients.

The Interdisciplinary Care Group  (GIC or MDT) supports the patient at every stage: from diagnosis, through treatment, to follow-up. Special attention is paid to nutritional support, psychological health and reintegration into daily life. The organization of checkups, examinations, and treatment is designed to ensure continuity, serenity, and a humane, caring approach to each patient’s needs.