Cervical Cancer
Cervical cancer is overwhelmingly associated with persistent high-risk human papillomavirus infection, which places it among the most preventable cancers through vaccination and screening.
Disease categories
Major disease categories
- Squamous cell carcinoma
- Adenocarcinoma
- Adenosquamous carcinoma
- Neuroendocrine carcinoma of the cervix
Molecular
Molecular considerations
HPV integration is central. PIK3CA alterations are frequently described. PD-L1 expression and mismatch repair status are assessed in advanced disease.
Markers commonly discussed in cervical cancer
- HPV status
- PD-L1
- PIK3CA
- MMR / MSI
- TMB
Not exhaustive, and not every marker is assessed in every patient. Which of these is relevant depends on the individual case and should be discussed with the treating team.
Testing
Genomic testing considerations
Profiling is discussed in recurrent and metastatic disease.
Germline
Germline considerations
Not routinely indicated, but considered where the clinical picture is unusual.
Molecular monitoring
ctDNA and liquid biopsy considerations
HPV circulating DNA is an area of research interest for monitoring.
Single-cell & computation
Single-cell and algorithmic approaches
Single-cell analysis in gynaecological cancer is applied to clonal structure at relapse, where the question is whether resistant disease was present from the outset or emerged under treatment. Single-cell DNA sequencing can identify reversion events in a subpopulation before they are detectable in bulk. Algorithmic work includes homologous recombination deficiency scoring from sequencing data, mutational signature analysis, and molecular classification pipelines.
Decisions
Treatment decision questions
Questions worth raising with a treating team when a decision is being made:
- Is the histological subtype documented, including neuroendocrine features if present?
- Has PD-L1 been assessed in advanced disease?
Resistance
Resistance and recurrence questions
- Has the disease been re-characterised at recurrence?
Trials
Clinical trial considerations
Biomarker status and prior therapy affect eligibility.
When a precision oncology review may help
A review is most useful where the standard pathway has been exhausted or where the picture is more complicated than a protocol accounts for — rare presentations, treatment resistance, complex or apparently contradictory molecular findings, or a decision between several defensible options.
The output is a structured analysis and a set of questions for the treating team. It is not treatment, and it does not replace the treating oncologist.