Therapy for Carcinoma of the Uterine Cervix; Part II: Surgery

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THE surgical treatment of cervical carcinoma has been subject to a tremendous burst of enthusiasm in the past ten years. Published surgical results might give one the false impression that the use of irradiation has been largely discarded; in Part I we and our associates1 discussed the importance of irradiative therapy. New surgical procedures have been made possible and old ones have been made safer by improved anesthetics, antibiotics, surgical technics, and an imaginative attitude on the part of surgeons. Some operations are so new that they have not yet been thoroughly evaluated, while other currently accepted operations are being misapplied or poorly executed. Because of these factors it is difficult to delineate precisely the indications and contraindications for the use of surgery.

This report concerns only invasive carcinoma of the uterine cervix. Carcinoma in situ is purposely excluded because we believe that that lesion represents an entirely different condition in many cases. We agree wholeheartedly with the suggestion of Blaikley, Kottmeier, Martius, and Meigs2 that carcinoma in situ be omitted from the clinical classification of carcinoma of the cervix. Although it does represent a major cellular abnormality, in many cases it is not a clear-cut entity. In most instances carcinoma in situ is amenable to local treatment if certain precautions in diagnosis and follow-up are observed. Our experience with an approach to the diagnosis and treatment of carcinoma in situ has been recently reported.3

The surgical treatment of invasive cervical carcinoma requires facilities and abilities for highly specialized technics.



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