Cervical cancer surgery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Nima Nasiri, M.D.[2]

Overview

The feasibility of surgery depends on the stage of cervical cancer at diagnosis. The mainstay of surgical management for cervical carcinoma is radical hysterectomy with pelvic lymphadenectomy.

Surgery

In Situ Cervical Cancer

Stage IA Cervical Cancer

  • Standard treatment options for stage IA1 cervical cancer include the following:[3][4]
  • Conization: for microinvasive carcinoma when the depth of invasion is less than 3 mm and there is no vascular or lymphatic invasion is noted, and the margins of the cone are negative, conization alone may be appropriate in patients who wish to preserve fertility.
  • Total hysterectomy: If the depth of invasion is less than 3 mm, which is proven by cone biopsy with clear margins, no vascular or lymphatic channel invasion is noted, and the frequency of lymph node involvement is sufficiently low, lymph node dissection at the time of hysterectomy is not required. Oophorectomy is optional and should be deferred for younger women.
  • Standard Treatment Options for Stage IA2 Cervical Cancer include the following:
  • For patients with tumor invasion between 3 mm and 5 mm, modified radical hysterectomy with pelvic node dissection has been recommended because of a reported risk of lymph node metastasis of as much as 10%. Radical hysterectomy with node dissection may also be considered for patients for whom the depth of tumor invasion was uncertain because of invasive tumor at the cone margins. Intraoperatively, the patient is assessed in a manner similar to a radical hysterectomy; the procedure is aborted if more advanced disease than expected is encountered. The margins of the specimen are also assessed at the time of surgery, and a radical hysterectomy is performed if inadequate margins are obtained.
  • Other Treatment Options
  • Radical trachelectomy: patients with stages IA2 to IB disease who desire future fertility may be candidates for radical trachelectomy. In this procedure, the cervix and lateral parametrial tissues are removed, and the uterine body and ovaries are maintained.
  • Most centers utilize the following criteria for patient selection:
  • Desire for future pregnancy.
  • Age younger than 40 years.
  • Presumed stage IA2 to IB1 disease and a lesion size no greater than 2 cm.
  • Preoperative magnetic resonance imaging that shows a margin from the most distal edge of the tumor to the lower uterine segment.
  • Squamous, adenosquamous, or adenocarcinoma cell types.

Stages IB and IIA Cervical Cancer

  • Other Treatment Options:[5]
  • Radical trachelectomy: patients with presumed early-stage disease who desire future fertility may be candidates for radical trachelectomy.

Recurrent Cervical Cancer

  • Pelvic exenteration: for locally recurrent disease, pelvic exenteration can lead to a 5-year survival rate of 32% to 62% in selected patients.[6]

References

  1. Roque DR, Wysham WZ, Soper JT (July 2014). "The surgical management of cervical cancer: an overview and literature review". Obstet Gynecol Surv. 69 (7): 426–41. doi:10.1097/OGX.0000000000000089. PMID 25112591.
  2. http://www.cancer.gov/types/cervical/hp/cervical-treatment-pdq#section/_93
  3. Sevin BU, Nadji M, Averette HE, Hilsenbeck S, Smith D, Lampe B (October 1992). "Microinvasive carcinoma of the cervix". Cancer. 70 (8): 2121–8. PMID 1394041.
  4. http://www.cancer.gov/types/cervical/hp/cervical-treatment-pdq#section/_104
  5. http://www.cancer.gov/types/cervical/hp/cervical-treatment-pdq#section/_110
  6. http://www.cancer.gov/types/cervical/hp/cervical-treatment-pdq#section/_147

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