A Surgical Approach to Cervical Carcinoma

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CERVICAL CARCINOMA may be treated by surgery or by irradiation therapy. The two forms of treatment should be thought of as being complementary rather than competitive. In considering surgical therapy, a middle-of-the-road approach seems most reasonable in the light of present knowledge.

Indications for Surgery

The treatment of choice in the majority of cases of cervical carcinoma is irradiation therapy since 70 to 75 per cent of women with this disease have evidence of its extension outside the cervix when they are first examined. It follows then that surgery is most commonly indicated in those cases in which there is a failure of response to irradiation therapy. Surgery may also be employed for the following purposes: (1) evaluation of response of a lesion to previous irradiation therapy; (2) palliation; (3) correction of conditions arising out of the use of x-ray or radium therapy; (4) complete pretreatment evaluation when undetermined extracervical pelvic pathology coexists with a Stage I or Stage II cervical carcinoma; and (5) treatment of carefully selected cases of Stage I and Stage II cervical carcinomas; these operations are being performed in some centers by highly competent surgeons.

It has been suggested that surgery be routinely advised upon a patient’s refusal to accept irradiation, but we believe that a patient cannot reasonably make a choice between therapeutic procedures which in most instances must be decided by the surgeon.

Contraindications to Operation

Contraindications to surgery are difficult to outline, for often surgical exploration itself is essential to complete evaluation of . . .



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