Cervical cancer, quality issues in early detection and prognostic factors

Abstract

It is expected that cervical cancer incidence will reduce in The Netherlands over the next decades, as a result of hrHPV vaccination and hrHPV-based screening. Untill then, quality of care could need some improvements as suggested by the work described in this thesis. Novel tools are being indicated to improve care and information is discussed on prognostic factors once cervical cancer has been diagnosed. In this thesis our first aim was to investigate the current and a novel colposcopy device in detecting premalignant cervical disease, and to describe the current situation in a subset of the Dutch population. Firstly the quality of care indicators and treatment outcome of five Dutch colposcopy clinics are described (Chapter 2). Secondly, the clinical performance of a digital colposcopy device is described in a prospective trial (Chapter 3). This study cohort is further analyzed in Chapter 4, showing a detailed analysis of a subset of patients with a specific HPV infection. Chapter 5 depicts an in-depth analysis of the diagnostic process followed in a cohort of patients with cervical cancer. Our second aim was to investigate prognostic factors once the diagnosis of cervical cancer has been established. Chapter 6describes the value of performing a lymph node dissection in addition to the sentinel node procedure. Chapter 7 analyzes the prognostic utility of a panel of serum markers tested in a cohort of cervical cancer patients with extensive follow-up. Finally, in Chapter 8 the results and conclusions of the conducted studies are discussed, and analyzed in the frame of the novel nationwide screening for cervical cancer.