Since infection with human papillomavirus (HPV) is the most important risk factor for cervical cancer and precancers, it is important to avoid genital HPV infection. This may mean delaying sex, limiting the number of sex partners, and avoiding a sex partner who has had several other partners. Condoms are important to prevent the spread of sexually transmitted diseases, but they can't give full protection against HPV since there may be skin to skin contact of exposed areas which can transmit the virus...
Revised text to state that cancer of the endometrium is the most common gynecologic malignancy in the United States, and irregular vaginal bleeding is an early sign and foremost symptom of the highly curable endometrial tumor.
Revised text to state that although the collection of cytology specimen is still suggested, a positive result does not upstage the disease.
Added text to state that Féderation Internationale de Gynécologie et d'Obstétrique stages are further subdivided by the histologic grade of the tumor, for example, stage IC G2.
Treatment Option Overview
Added text to state that the results of a study by the Danish Endometrial Cancer Group also suggest that the absence of radiation does not improve the survival of patients with stage I, intermediate-risk disease (cited Bertelsen et al. as reference 4).
Revised text to state that vaginal cuff brachytherapy is associated with less radiation-related morbidity than is external-beam radiation therapy (EBRT) and has been shown to be equivalent to EBRT in the adjuvant setting for patients with stage I disease (cited Nout et al. as reference 5). A subset of patients with stage I disease are at a high risk of recurrence and are eligible for adjuvant therapy; however, most patients will do well with surgery alone.
Stage I Endometrial Cancer
Added text to state that results of a study by the Danish Endometrial Cancer Group also suggest that the absence of radiation does not improve the survival of patients with stage I, intermediate-risk disease (cited Bertelsen et al. as reference 9).
Added text to state that the PORTEC-2 trial randomly assigned patients with stage I endometrial cancer who did not undergo lymph node dissection to undergo vaginal brachytherapy (VBT) or EBRT, with prevention of vaginal recurrence as the primary outcome. At 5 years, there was no difference in the rates of vaginal recurrence, locoregional recurrence, progression-free survival, or overall survival (OS), for VBT and EBRT, respectively; however, there were significantly fewer gastrointestinal toxic effects in the VBT group, making VBT the preferred option for adjuvant treatment in patients with stage I disease (cited Nout et al. as reference 10 and level of evidence 1iA).