Modern treatment of invasive carcinoma of the uterine cervix

Abstract

Treatment of invasive cervical carcinoma is determined by the clinical disease stage. Microinvasive carcinoma of the uterine cervix, due to its limited metastatic potential, is usually curable with non-radical treatment. There are no standard approaches to the treatment of stage Ib-IIa carcinoma of the uterine cervix. Both radical surgery and radical radiotherapy are utilized with similar efficacy but with different associated morbidity and complications. Stage Ib1 was commonly treated with radical hysterectomy plus pelvic lymphadenectomy. Laparoscopically-assisted radical vaginal hysterectomy demonstrated similar efficacy and recurrence rates for this disease stage. In cases where fertility is to be preserved, radical vaginal trachelectomy is a valid option for small cervical cancers. Among the papers dealing with bulky cervical disease (stages Ib-IIa) a great deal of disagreement is evident. Some oncologic centres prefer primary surgery with postoperative radiotherapy, with or without chemotherapy, while others prefer primary chemoradiotherapy. Moreover, as a possible alternative, neoadjuvant chemotherapy followed by radical surgery is recommended for stage Ib2 disease. Simultaneous chemoradiation is being introduced as a new standard for advanced cancer, since it has been clearly demonstrated that it can prolong disease-free and overall survival. The treatment of recurrent carcinoma depends on the type of previous treatment, site and extent of recurrent disease, and on the disease-free period and general health of the patient. In conclusion, the decision on the treatment approach for invasive carcinoma of the uterine cervix should be individualized, based on numerous factors, such as disease stage, general health of the patient, cancer-related factors, in order to choose the best approach with minimal complications.