The role of clinical follow up in early stage cervical cancer in South Wales

OBJECTIVE: To assess the effectiveness of clinical follow up after primary surgery for early stage cervical cancer. DESIGN: Retrospective analysis of clinical follow up after radical hysterectomy and node dissection for early stage cervical cancer. SETTING: Gynaecological Oncology Cancer Centre. SAMPLE: Two hundred and ninety-one patients who underwent surgery for cervical cancer. METHODS: Follow up data were collected retrospectively from hand-searched patients notes, as well as a computerised database (Information System for Clinical Organisation ISCO). The data were analysed using the SPSS for windows (SPSS, Chicago, Illinois) statistics package, using chi2, Kaplan-Meier life tables and Cox Linear regression analysis. MAIN OUTCOME MEASURES: To determine whether routine follow up was useful for detecting early recurrent disease. RESULTS: Two hundred and ninety-one patients treated by radical hysterectomy and node dissections were followed up. The cumulative five-year survival for all cases in our series was 80% and 53/291 patients (18.2%) were found to have recurrent disease. The median period from surgery to recurrence was 17.6 months (3.0-60.0). Seven patients with recurrence were detected at a routine follow up examination, and two out of seven of the patients were asymptomatic. Detection of the recurrence on routine follow up was not an independent prognostic factor for survival when compared with age, stage and whether the patient received post-operative adjuvant therapy. CONCLUSIONS: Routine follow up in patients following radical hysterectomy and node dissection for early stage cervical cancer is not a sensitive way of detecting recurrent disease, as a high proportion of patients were symptomatic at the time of detection. As there are other reasons for follow up, we propose alternative methods of structuring the programme.