Approach in Patients with Cervical Cancer Detected Coincidentally after Surgery
The treatment schemes you may see below are shaped under the scope of NCCN Guidelines Version 1.2017 Cervical Cancer (https://www.nccn.org/professionals/physician_gls/f_guidelines.asp), ESMO Cervical Cancer Guideline 2017 (http://www.esmo.org/Guidelines/Gynaecological-Cancers/Cervical-Cancer) and the directives published by the Gynecological Oncology Algorithm Group (Gynecological Tumors, Diagnosis-Treatment-Follow up, Cervical Cancers. Ed: A.Aydıner, I.Aslay, S.Berkman. Nobel Tıp Kitapevi. 2016: 123-169) (http://tukod.org/folders/file/WWeb_JT_2016(1).pdf).
Sometimes when the patient is not evaluated enough before the surgery or especially in adenocarcinomas and patients in menopause, as the tumor cannot be seen from outside or it is at a very early stage, the hysterectomy made for different reasons (for example let us think there is a womb removal surgery due to myoma), at the pathology report after surgery the presence of cervical cancer is seen.
In this case, first of all the patient should be staged via examination, imaging methods (PET CT; MRI) and laboratory findings. After this work, depending on the stage and the pathology results acquired after surgery the treatment is shaped.
. If Stage IA1 and LVAI are not present it is recommended that the patient is followed.
If Stage 1A1 and LVAI is present / in patients with high grade (bad cells) or at Stage IA2 the treatment is determined according to the margins of the piece removed with surgery.
a. If the margins are positive i.e. tumor remains then Radiotherapy and subsequently chemotherapy are recommended.
b. If the margins are negative Radiotherapy or parmetrectomy surgery + lymph node removal can be applied surgically. In patients with high risk chemotherapy is also given in addition.