There are many surgical treatments for cervical cancer. Which one is more suitable?

Author: Wu Ming, Chief Physician, Peking Union Medical College Hospital

Reviewer: Bai Wenpei, Chief Physician, Beijing Century Altar Hospital, Capital Medical University

The early symptoms of cervical cancer are not very specific. Vaginal bleeding after sexual intercourse, or abnormal vaginal bleeding, especially accompanied by some yellow, smelly secretions, should alert you to cervical cancer. Timely medical treatment can lead to early detection.

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1. How is cervical cancer staged?

The International Federation of Gynecology and Obstetrics divides cervical cancer into stages I, II, III, and IV.

Generally speaking, if the tumor is confined to the cervix, it is called stage I; if it exceeds the cervix and invades the paracervix and vagina, it is called stage II. Stage II is divided into stage IIA and stage IIB. Stage IIA is only vaginal invasion, but it does not reach the lower 1/3, and stage IIB is paracervical infiltration, but not to the pelvic wall; if there is paracervical infiltration, it is called stage III. If it does not infiltrate the pelvic wall, but the vagina invades the lower 1/3, it is called stage IIIA, and if it infiltrates the pelvic wall, it is called stage IIIB; if metastasis occurs, it is called stage IV. Pelvic metastasis, including involvement of the bladder and rectum, is called stage IVA, and distant metastasis, such as lung and supraclavicular lymph node metastasis, is called stage IVB.

The five-year survival rate of stage I cervical cancer is approximately 80%-90%; the five-year survival rate of stage II cervical cancer is approximately 50%-70%; the five-year survival rate of stage III cervical cancer is approximately 30%-40%, and can be as high as 50%; the five-year survival rate of stage IVB cervical cancer does not exceed 10%.

The main treatments for cervical cancer include surgery, radiotherapy and chemotherapy. For young patients with early cervical cancer, radiotherapy can cause a lot of harm, including damage to the ovaries and vagina, so surgical treatment is recommended as the first choice.

2. What are the surgical treatments for cervical cancer?

The simplest surgical treatment for cervical cancer is cervical conization, especially for early stage IA1 cervical cancer. If you want to have children, you can do cervical conization, which is to make a cone-shaped excision of the cervix, cut off the transitional zone, and then do a pathological examination to see the extent of the cervical cancer.

The second surgical method is called simple hysterectomy, in which the entire uterus is removed. It is mainly suitable for patients with stage IA1 cervical cancer who have no fertility requirements.

There is another type of surgery called radical hysterectomy. In addition to removing the uterus, the surrounding 4 cm of tissue, including parauterine tissue, lymph nodes, and part of the vagina, must be removed. This is the most important surgery for treating cervical cancer. Radical hysterectomy is required for stage IA2, stage IB1, and stage IB2 cervical cancer. A small number of stage IA1 cervical cancer patients are found to have lymphovascular space involvement after cervical conization. If surgery is required to solve the problem, radical hysterectomy is also required.

If cervical cancer recurs after radical surgery, or locally recurs after chemotherapy, as long as the tumor is local, a small number of patients can undergo pelvic exenteration, also known as pelvic organ clearance, to remove all organs in the pelvis affected by the tumor, including the bladder, rectum, vagina, and uterus, and a fistula is required. This type of surgery has a very high rate of complications, and the perioperative mortality rate is very high.

Radical hysterectomy for cervical cancer is the most commonly performed and classic surgery for early cervical cancer. It can be performed through laparotomy, laparoscopy, or robot. The hysterectomy can also be performed vaginally, followed by laparoscopic-assisted lymph node removal.

3. What are the advantages of laparoscopic radical hysterectomy for cervical cancer compared with open surgery?

Compared with traditional surgery, laparoscopic radical cervical cancer surgery can magnify many times, so the organs in the pelvic cavity can be observed more carefully and clearly. In addition, the laparoscopic incision is small, and the operation is performed with instruments, so the blood vessels can be closed before cutting, bleeding is usually minimal, and recovery is fast after surgery.

Another great advantage of laparoscopic radical surgery for cervical cancer is that gastrointestinal function recovers quickly. Most patients pass gas on the second day after surgery. The passing of gas means that gastrointestinal function has recovered and they can eat. The effect is quite good.

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After laparoscopic radical hysterectomy for cervical cancer, as long as hysterectomy is involved, pathological results are generally checked 1-2 weeks after surgery to determine whether other adjuvant treatments are needed based on pathological staging. A follow-up examination is performed 6 weeks after surgery to see how the recovery is going. There is nothing wrong with a follow-up examination 6 weeks after surgery. A follow-up examination is performed every 3 months for the first two years after surgery, every 6 months for three to five years after surgery, and once a year after five years. A follow-up examination is required for life.