Cervical cancer #2.

Treatment Options

 The treatment of cervical cancer is similar to the treatment of any other type of malignancy in that both the primary lesion and potential sites of spread should be evaluated and treated. The therapeutic modalities for achieving this goal include primary treatment with surgery, radiotherapy, chemotherapy, or chemoradiation. Whereas radiation therapy can be used in all stages of disease, surgery is limited to patients with stage I to IIa disease. The 5-year survival rate for stage I cancer of the cervix is approximately 85% with either radiation therapy or radical hysterectomy. A recent study using the National Cancer Institute's Surveillance Epidemiology and End Results data showed by an intent-to-treat analysis that patients in the surgery arm had an improved survival when compared with patients in the radiation arm (56). In general, optimal therapy consists of radiation or surgery alone to limit the increased morbidity that occurs when the two treatment modalities are combined. There have recently been great strides in the treatment of cervical carcinoma, including adjuvant chemoradiation in patients discovered to have high-risk cervical carcinoma after radical hysterectomy and in patients with locally advanced cervical carcinoma.

Surgery

There are advantages to the use of surgery instead of radiotherapy, particularly in younger women for whom conservation of the ovaries is important. Generally, it is prudent not to operate on lesions that are larger than 4 cm in diameter because these patients will require postoperative radiation therapy. If radiation therapy is needed, ovarian function may be preserved by transposing the ovaries out of the planned radiation field. While transposition may provide some protection, some studies suggest that normal ovarian function is preserved in fewer than 50% of patients.

Management of Invasive Cancer of the Cervix

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