Cervical carcinoma: When is surgery an option?

Cervical cancer is one of the most common forms of cancer in women. Various surgical and conservative treatments exist, but which therapy is suitable for which patient?

Surgical therapies for cervical carcinoma

The aim of treatment for cervical cancer is always an R0 resection.
A simple hysterectomy can be performed for small low-risk tumours.
If R0 conization is not achieved, but appears achievable, a repeat procedure should be considered to determine the exact extent of the tumour.
For early stage and larger tumours that do not meet the SHAPE criteria, a radical hysterectomy is the treatment of choice.
If surgical removal of the cervical carcinoma is not possible, but a curative treatment approach is, surgical lymph node staging is recommended in most cases in order to define the radiotherapy field.

Smaller tumours: is conisation a predictive factor?

Current study data suggest that patients suffering from low-risk cervical carcinoma have better outcomes if clean margins, i.e. R0 status, are achieved in the initial conisation. Low-risk carcinoma is defined as a tumour less than 2 cm in size, with less than 10 mm of stromal invasion and negative lymph nodes. However, it is not so easy to say whether this is really a predictive factor. After all, other factors also play an important role in the treatment and prognosis of cervical carcinoma.

And what to do with larger tumours?

For tumours between 2 cm and 4 cm in size, the procedure of choice is a primary laparotomy for lymph node staging and (if the lymph nodes are negative) a radical hysterectomy. A sentinel lymph node biopsy may also be considered.

What are the options in cases of inoperability?

If uterine surgery is not possible for a patient but there is a curative treatment situation, the experts still recommend lymph node staging. Lymph nodes should be removed from the pelvic area and, if necessary, also para-aortically. This primarily serves to more precisely determine the radiation field.

The significance of the R0 margin

In the case of cervical carcinoma, an R0 margin should always be aimed for during conisation. If this is not the case, the procedure can be repeated in some cases. Depending on the result, a simple hysterectomy can then be performed in selected cases based on the results of the SHAPE study. For larger tumours, an open radical hysterectomy is the procedure of choice. These recommendations are based on current study results that have analysed the outcomes after corresponding interventions.

Source

Mahner, Sven, Prof. Dr. med., Universitätsklinikum München, Charité-Mayo-Conference distilled 2024, Revolution in Cervical Cancer Surgery? Radical Hysterectomy, Simple Hysterectomy, or Cone Biopsy in Early-stage Cervical Cancer , 13.04.2024