SURGICAL MANAGEMENT OF

CARCINOMA CERVIX

PRESENTED BYDR.AYUSH GARG

PG JR IRADIOTHERAPY

Management of Invasive Cancer of the Cervix

Stage Ia1

≤3 mm invasion, no LVSI Conization or Type I HysterectomyNo excision of parametrium

≤3 mm invasion, with LVSI Radical Trachelectomy or Type I/Type II Radical Hysterectomywith pelvic lymph node dissection

la2 3–5 mm invasion Radical Trachelectomy or Type II Radical Hysterectomywith BPLND or RT for inoperable patients

lb1 >5 mm invasion, <2 cm Radical Trachelectomy or Type III Radical Hysterectomywith BPLND

>5 mm invasion, >2 cm Type III Radical Hysterectomy with BPLND

lb2 >5 mm invasion,>4cm Type III radical hysterectomy with pelvic and paraaortic lymphadenectomyor primary chemoradiation

Stage IIa Type III Radical Hysterectomy with pelvic and paraaorticlymphadenectomy or primary chemoradiation

IIb, IIIa, IIIb Primary Chemoradiation

Stage IVa Primary Chemoradiation or primary exenteration

IVb Primary Chemotherapy ± Radiation

Classification of extent of operation1.(Type I ) Extrafascial Hysterectomy

2.(Type II) Modified Radical Hysterectomy/ Wertheim Hysterectomy

3.(Type III) Radical Hysterectomy/ Meigs-Wertheim Hysterectomy

4.(Type IV) Extended Radical Hysterectomy

5.Type V Operation: Exenteration

Simple Hysterectomy (Type I)• Also known as an extrafascial hysterectomy,

removes the uterus and cervix, but does require excision of the parametrium.

• It is appropriately selected for stage IA1 cervical cancer.

Modified Radical Hysterectomy (Type II)• Modified radical hysterectomy removes the cervix, proximal vagina(1-2cm), and

parametrial and paracervical tissue.

• This hysterectomy is well suited for tumors with 3- 5mm depths of invasion and smaller stage IB tumors.

Radical Hysterectomy (Type III)• Requires greater resection of the parametria, and excision extends to the pelvic sidewall .• In addition, at least 2 to 3 cm of proximal vagina is resected. • This procedure is performed for larger IB lesions/IIA lesions, and for patients with relative

contraindications to radiation such as diabetes, pelvic inflammatory disease, hypertension, collagen disease or adnexal masses.

Type IV - Extended radical hysterectomy Removal of all periureteral tissue, superior vesicle artery and ¾ of vagina.

Differfrom the type III procedure—three fourths of thevagina and paravaginal tissue are excised.

Type V - ExenterationThe terminal ureter or a segment of the bladder or rectum is removedalong with the uterus and parametria(supralevatorial).

Radical Trachelectomy

• Also known as cervicectomy, is a surgical removal of the uterine cervix.

• As the uterine body is preserved, this type of surgery is a fertility preserving surgical alternative to a radical hysterectomy and applicable in selected younger women with early cervical cancer

• It is appropriately selected for stage IA1/IA2/IIA cervical cancer.

Conization

It is used both for diagnostic and therapeutic purpose

Removal of cone of the cervix which includes Squamocolumnar junction,stroma with glands and endocervical mucous membrane

Methods: Cold Knife,CO2 laser, Laser diathermy loop

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