Complications
The most common adverse effects of programmed cell death protein-1 (PD-1) or programmed cell death ligand-1 (PD-L1) inhibitor therapies are: anemia (45.4%), fatigue (34.3%), dysphagia (30.0%), neutropenia (19.6%), lymphopenia (10.2%), hypertension (9.3%), and elevated lipase (7.2%).[217] Other potential adverse effects include colitis, myocarditis, pericarditis, and skin toxicities.[218]
Guidelines for monitoring of patients and management of complications are available.[201][219][220] A range of cardiovascular complications have been reported and may be more common than previously reported.[221]
Should be treated with vaginal packing, with or without the use of topical Monsels, epinephrine, acetone, or aminocaproic acid. Radical hysterectomy can be performed if necessary and if the lesion is amenable. A short course of radiation therapy can be effective as well, and should be integrated into the overall treatment plan if fertility preservation is not desired. Use of arterial embolization is less acceptable.
A surgical complication that is often a complex of both instability and denervation. Nerve-sparing surgery (type C1 hysterectomy) may reduce risk of this complication.[119]
Limited evidence suggests that bethanechol may minimize the risk of bladder dysfunction by lowering post‐void residual urine volume. The effectiveness of different types of postoperative urinary catheterization (suprapubic and intermittent self‐catheterization) remains unproven.[209] Further research is needed for these and other potential treatments (e.g., cisapride, bladder training, and acupuncture).
Late consequences of radiation therapy. Women who receive a higher radiation dose or who have tumor extension into the vagina are at higher risk.[213] Maintenance of vaginal patency with vaginal dilators during and after radiation therapy is important not only to preserve sexual function, but also to permit adequate follow-up pelvic examinations.[214]
Reported prevalence varies considerably.[210][211][212] Patient education and counseling (preferably involving both partners) are very important components of managing sexual dysfunction. Pharmacologic approaches include topical estrogens and transcutaneous testosterone. Referral to a physical therapist with expertise in pelvic floor-related conditions may also be of benefit.
Late consequence of radiation therapy.[214] Early referral to a lymphedema clinic is encouraged.
Later consequence of radiation therapy, affecting 3.4% of women after 5 years.[215]
A surgical complication that may cause considerable disability.
Local excision and ablation treatments for preinvasive and early invasive cancer increase the risk of preterm birth in subsequent pregnancy.[111]
Late consequences of radiation therapy. Risk approximately 3% after 5 years.[216]
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