Operative management of cervical cancer.
Radical abdominal hysterectomy with pelvic lymph node dissection remains the treatment of choice for most patients with early-stage cervical cancer. The radicality and extent of lymph node dissection and parametrial resection should be tailored to tumour- and patient-related risk factors. Adjuvant therapy after radical surgery improves local control in high-risk patients and some intermediate-risk patients. The absolute indications for adjuvant therapy include multiple or macroscopically involved nodes, parametrial invasion and positive surgical margins. Adjuvant therapy may be given as chemoradiation or as radiotherapy alone, depending on risk assessment and expected morbidity. Primary chemoradiation is an equally effective alternative, but adjuvant surgery or finishing hysterectomy after pelvic radiation is not beneficial. Promising new developments include neo-adjuvant chemotherapy followed by surgery for bulky early-stage disease, tailoring radicality to reduce therapeutic morbidity and integrating minimal access surgical techniques into current treatment protocols.
Dreyer
G
G
Department of Obstetrics and Gynaecology, University of Pretoria, P.O. Box 667, Pretoria 0001, South Africa. greta.dreyer@mweb.co.za
D001803:Blood Transfusion / Q000379:methods; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods; D015907:Hysteroscopy / Q000379:methods; D008197:Lymph Node Excision / Q000379:methods; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D010053:Ovary / Q000601:surgery; D011182:Postoperative Care / Q000379:methods; D018714:Radiotherapy, Adjuvant; D012307:Risk Factors; D021701:Sentinel Lymph Node Biopsy / Q000379:methods; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*