Cervical Cancer! Further mx?

A 45-year-old woman, G3P1, presented with menometrorrhagia. Diagnosed as high-grade squamous intraepithelial neoplasia. Patient undergone cold knife conization & pathology report shows squamous cell carcinoma of cervix with a depth of stromal invasion & lateral spread. To avoid future risk should we go for total hysterectomy?



If lateral spread up to lateral pelvic wall on per rectal examination then it is stage 3 . So radiotherapy is treatment of choice. Wertheim is not indicate at this stage. If stage 4 then palliative radiotherapy and chemotherapy may required . Surgery is indicated for stage 1 and stage 2 in which only upper 3 rd of vagina involved. SO IN MY OPINION RATHERBTHEN GOING FOR HYSTERECTOMY IF LATERAL PELVIC WALL INVOLVED THEN GO FOR RADIOTHERAPY.

With this approach you can not stop the spread in pelvic bone or sacrum and lumbar vertebrae and hence earliest urredication of lesion by radical surgery can give a length of life yes post operative followup is chemo or pallaiative with radiotherapy

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Up to stage 2 A radical hysterectomy, 2 B to 3 radiotherapy, stage 4A-4B palliative chemoradition. If lateral spread is confirmed to only cervix then after ruling out distant spread radical hysterectomy indicated . But if lateral parametrium involved then better to go for intra cavitory radiotherapy. I have seen radiotherapy taken in 1992 still come to follow up in 2010/11 at GCRI ,AHEMDABAD AT OUR UNIT DURING MY RESIDENSY.

I misunderstood the lateral spread as it is in cold knife conization biopsy histopathology report this ot should undergo radical hysterectomy and then after complete histopathology further chemoradition depends. But if lateral spread up to lateral pelvic wall then definitely radiotherapy is my opinion.

Indeed she has to go under total hystero- Oophrectomy Followed by chemoradiotherapy Before that adv MRI LS region and r/o bony metastasis

Invasive squamous cells carcinoma of cervix Adv Total radical hysterectomy

total abdominal hysterectomy with bilateral salphingo oophorectomy followed by chemo/radiotherapy

Known case of ca cervix Hysterectomy with ophrectomy with adjacent nodes Opinion of oncosurgeon

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