Staging laparotomy and radical hysterectomy for cancer of the cervix

Clinical staging does not define the true extent of disease in approximately one-third of the patients with early cervical cancer. Unless clear nodular tumour extension into the parametria is palpable a patient should be considered for surgical therapy. This involves a thorough staging laparotomy, including the exploration of the pelvic retroperitoneal spaces and para-aortic node dissection. If the disease appears to be confined to the cervix a radical hysterectomy and pelvic lymphadenectomy is performed. If gross tumour invasion into the parametria, the bladder, or rectum muscularis is documented, the patient is treated with pelvic radiation. If microscopic distant metastases to the para-aortic nodes are found, extended field radiation and possible chemotherapy is the treatment of choice. Survival is determined mostly by the extent of disease at the time of treatment. Therapy has to encompass the whole region affected by disease in order to provide the patient with a chance of cure. For disease beyond the cervix, regional radiation makes more sense. Just as in the study published by Zander's group (Zander et al, 1980), we add radiation if microscopic disease beyond the cervix is found after a radical hysterectomy. However, additional radiation adds morbidity, length of therapy, and cost. Unless there is clear proof that adequate primary radiation is inferior to surgery and postoperative radiation we recommend radiation for cancer of the cervix with proven Stages IIb and above. The benefit of systemic chemotherapy as an alternative to postoperative radiation needs to be evaluated.(ABSTRACT TRUNCATED AT 250 WORDS)