Treatment of cervical cancer depends on the stage of the cancer:
· Stage 0 – Cervical excision procedure (CKC or LEEP)
· Stage Ia1 – Hysterectomy without lymph node dissection
· Stage Ia2-Stage IIa – Radical hysterectomy with a pelvic lymph node dissection or radiation therapy with combination chemotherapy
· Stage IIb or greater – Radiation therapy with combination chemotherapy
There are two basic histological types of cervical cancer; squamous cell and adenocarcinoma. Because adenocarcinoma is thought to have skip lesions (cancerous tissue next to normal tissue and the cancerous tissue), it is treated differently in the earlier stages. A radical hysterectomy with pelvic lymph node dissection or radiation with chemotherapy would be recommended for Stage Ia or greater. A patient with Stage 0 and negative margins could undergo a hysterectomy.
It is important to note that despite finding metastasis during surgery, a patient’s stage does not change from the original clinical stage. However, it does influence the treatment options after surgery. Although studies have shown equal 5-year survival rates for either radical hysterectomy versus radiation with chemotherapy, a patient that undergoes surgery and then requires radiation and chemotherapy has a much greater morbidity as a result. The decision to proceed with one or the other is often influenced by the patient’s health status, co-morbid conditions, and the surgeon’s training and experience (60). A patient’s desire to retain her fertility options are discussed and considered in the treatment. There have been some centers that perform radical trachelectomy (removal of the cervix only), however, these are still considered experimental.