Surgical treatment of cancer of the cervix

Evolution of surgical treatment, the interplay between treatment modalities and specific recommendations for the type and radicality of surgery necessary for the cure of cervical cancer are presented. The place of surgical staging in the management of large volume tumors is addressed. Computerized tomography (CT scans) and Magnetic Resonance Imaging techniques are unlikely to replace surgical staging in the near future due to their lack of sensitivity and specificity, yet these techniques combined with fine needle aspiration (FNA) of suspicious abdominal or pelvic lymph nodes can assist the oncologist in determining the necessity for extended field radiotherapy. In the absence of positive findings by FNA, young healthy patients with large volume tumors should be offered extraperitoneal surgical staging to aid in treatment planning. Radical surgery for early Stage (IB, IIA) tumors is as likely to result in cure as surgery combined with radiotherapy or chemotherapy, although the availability in the future of more sensitive chemotherapeutic agents may allow such systemic adjuvant therapy to play a larger role. Exenterative surgery still has a place as salvage therapy in this disease but as radiotherapy becomes more effective, its role diminishes.