Cervical cancer: Current management of early/late disease Review

McCreath, WA, Salom, E, Chi, DS. (2005). Cervical cancer: Current management of early/late disease . Surgical Oncology Clinics of North America, 14(2), 249-266. 10.1016/j.soc.2004.11.006

cited authors

  • McCreath, WA; Salom, E; Chi, DS

abstract

  • The evolution in the surgical management of cervical cancer dates back to the late nineteenth century. Many improvements have been made in the operative technique of the radical hysterectomy and pelvic lymphadenectomy since their original description. The incidence of complications after this procedure has decreased during the past three quarters of a century, and the survival rates have increased. The operation has achieved its peak of clinical usefulness during this period and is now considered to be the principal method of treatment of early invasive carcinoma of the cervix. When performed by well-trained gynecologic oncologists, the meticulous execution of this operative procedure has reduced the incidence of complications to an acceptable and infrequent occurrence. The operation affords little additional surgical risk to the patient than a hysterectomy performed for benign disease. Newer laparoscopic approaches are promising, with comparable cure rates and the potential to retain fertility in carefully selected patients. Comparative studies with primary radiotherapy have shown an equal cure rate with primary radical surgery in the treatment of early-stage disease. The complications of irradiation are far more difficult to manage than are those of primary surgery, however. In young women, when preservation of ovarian function is important, primary surgery is a preferable choice of treatment. The major limiting factor in the long-term surgical cure of cervical cancer is related to the spread of the disease at the time of initiation of treatment. Historically, in patients in whom pelvic lymph nodes were positive for metastatic tumor, the 5-year cure rate was reduced to approximately 60%. Numerous recently reported prospective, randomized trials have shown the benefit of concurrent chemotherapy and radiation therapy in various settings. In the management of high-risk patients after radical hysterectomy and pelvic lymphadenectomy, including those with positive nodes, the reported 4-year disease-free survival rate is 81%. It is important to understand that it is the individual surgical expertise that offers the highest cure rate and lowest incidence of complications to the patient with invasive carcinoma of the cervix. One of the greatest errors in clinical judgment is made by gynecologists who attempt a radical hysterectomy and pelvic lymph node dissection without adequate surgical training and experience. Unless the pelvic surgeon is performing this type of surgery regularly in a well-staffed medical center with trained assistants, he or she would be well advised to refer the patient to an established gynecologic oncologist. From the patient's point of view, the initial treatment, whether primary surgery or irradiation, provides the best chance for long-term cure of this disease. It would be to her advantage to have the treatment conducted in the most expert hands because secondary treatment for recurrent disease offers only limited potential long-term cure. Gynecologic surgeons who become thoroughly familiar with the pathology and natural history of cervical cancer, who appreciate the history of the development of radical hysterectomy and pelvic lymphadenectomy as primary treatment of the disease, and who then thoroughly master the technical details of performing the operation can feel enormous pride in their achievement because there is no greater challenge in gynecologic surgery and no greater personal satisfaction than that which comes to those who are able to perform the operation correctly and save a woman from the intense suffering and undignified death that cervical cancer can cause [4]. © 2005 Elsevier Inc. All rights reserved.

authors

publication date

  • January 1, 2005

published in

Digital Object Identifier (DOI)

start page

  • 249

end page

  • 266

volume

  • 14

issue

  • 2