Stage IIB and IVA Cervical Cancer Treatment
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).
The treatment approach in this patient group is chemo-radiotherapy. At this point what is to discussed is if some tumor is left after chemo-radiotherapy should a basic (Type 1) womb removal surgery be performed to the patient.
This is an issue discussed greatly. Let me try to explain via an example. The patient has a Stage IIB tumor. Pelvic radiotherapy and chemotherapy are performed. Tumor is removed but only 1 cm at the cervix canal and small amount inside the womb remained or after PET-CT/MRI it is thought that it remained. Should this patient receive brachytherapy (radiotherapy applied through vagina) or should simple womb removal surgery be applied then the condition is assessed and if necessary then brachytherapy is applied?
Complementary womb removal surgery, even though it is a surgery that is open to complications after radiotherapy, is a safe application at an experienced hand. However there are no findings up to now that it prolongs survival. Then what is the point? It increases the control at the region where the tumor develops. Thus it can be applied and is a good approach in well selected patients.