Current Therapeutic Approaches in Cervical Cancer Based on the Stage of the Disease: Is There Room for Improvement?

Abstract

Cervical cancer continues to be among the most common malignancies in women, and in recent decades, important measures have been taken to reduce its incidence. The first and most important steps to achieve this goal are oriented toward prevention through screening programs and vaccination, mainly against oncogenic human papillomavirus (HPV) strains 16 and 18. The therapeutic approach is based on the diagnosis and treatment guidelines for cervical cancer, which establish for each stage (FIGO, TNM) specific conduct. These guidelines summarize quite precisely the elements of therapeutic practice, but, in some places, they leave optional variants based on which nuanced approaches could be established. Adherence to these guidelines, which include the performing of minor or major surgery, with or without chemotherapy and radiation therapy, combined with advanced imaging investigations, has been able to lead to a substantial increase in survival. The purpose of this literature review is to discuss the diagnosis and treatment options in cervical cancer depending on the histological type, FIGO staging, and patient performance index, taking into account the hospital resources available in middle-income countries (percentage of gross domestic product allocated to health services around 5.5%, in the case of Romania).

Keywords: FIGO; cervical cancer; hysterectomy; lymph nodes; oncology; radiotherapy; surgery.

Figure 1

Evolution of surgery in genital cancer [14,15,16,17,18,19,20,21].

Figure 2

Intraoperative view during radical hysterectomy. Ovaries and fallopian tubes are removed, and uterus is tractioned for easier separation of cervix and posterior bladder wall. UB—urinary bladder, U—uterus, U—up, D—down, R—right, L—left.

Figure 3

Intraoperative view during ilio-obturatory lymphadenectomy. The external iliac vessels and ureter are visualized, and the surrounding fat-containing lymph nodes are removed. RL—Round ligament ligated, R—rectum, Ur—right ureter, EIV—External iliac vessels, UB—urinary bladder, U—up, D—down, R—right, L—left.

Figure 4

Intraoperative view of a patient during pelvic exenteration with bulky ilio-obturatory metastasis. SC—sigmoid colon. SI—small intestine. IOT—ilio-obturatory tumor. U—up, D—down, L—left, R—right.