To review the available evidence on post-treatment follow-up and recurrence management after cervical cancer.

We conducted a narrative review of the literature on surveillance modalities, and the management of pelvic and nodal recurrences.

Most recurrences occur within three years of treatment, but the survival benefit of detection before symptom onset remains unproven. After fertility-sparing surgery, HPV testing is sensitive for detecting asymptomatic pelvic recurrence. After hysterectomy, most recurrences are symptomatic, and clinical examination has a higher diagnostic yield than HPV testing or vaginal vault cytology. After concurrent chemoradiotherapy (CRT), persistent HPV infection is associated with an increased recurrence risk, but its limited specificity and the absence of a validated HPV-based surveillance strategy restrict its clinical utility. MRI and FDG PET/CT are useful for response assessment and investigation of suspected recurrence, but evidence supporting routine imaging of asymptomatic patients is lacking. Intensive follow-up schedules have not improved recurrence detection or survival. Evidence on recurrence management is predominantly retrospective. Pelvic recurrences after primary surgery have been treated with CRT, supplemented by brachytherapy for vaginal involvement. In selected patients with central pelvic recurrence after CRT, complete surgical resection may provide prolonged survival, but carries substantial morbidity. Nodal recurrences outside previously irradiated fields have been treated with CRT.

Available evidence supports a predominantly clinical, treatment-adapted follow-up. The survival benefit of intensive surveillance, routine imaging, or detecting asymptomatic recurrence remains uncertain. Recurrence management requires individualized multidisciplinary assessment based on disease extent, disease-free interval, and previous treatments.