Surgical management of carcinoma cervix

A small presentation on surgical management of carcinoma cervix

1. SURGICAL MANAGEMENT OF CARCINOMA CERVIX PRESENTED BY DR.AYUSH GARG PG JR I RADIOTHERAPY

2. Management of Invasive Cancer of the Cervix Stage Ia1 ≤ 3 mm invasion, no LVSI Conization or Type I Hysterectomy No excision of parametrium ≤ 3 mm invasion, with LVSI Radical Trachelectomy or Type I/Type II Radical Hysterectomy with pelvic lymph node dissection la2 3–5 mm invasion Radical Trachelectomy or Type II Radical Hysterectomy with BPLND or RT for inoperable patients lb1 > 5 mm invasion, <2 cm Radical Trachelectomy or Type III Radical Hysterectomy with BPLND > 5 mm invasion, >2 cm Type III Radical Hysterectomy with BPLND

3. lb2 >5 mm invasion,>4cm Type III radical hysterectomy with pelvic and paraaortic lymphadenectomy or primary chemoradiation Stage IIa Type III Radical Hysterectomy with pelvic and paraaortic lymphadenectomy or primary chemoradiation IIb , IIIa , IIIb Primary Chemoradiation Stage IVa Primary Chemoradiation or primary exenteration IVb Primary Chemotherapy ± Radiation

4. Classification of extent of operation (Type I ) Extrafascial Hysterectomy (Type II) Modified Radical Hysterectomy / Wertheim Hysterectomy (Type III) Radical Hysterectomy / Meigs -Wertheim Hysterectomy (Type IV) Extended Radical Hysterectomy Type V O peration : Exenteration

5. 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.

6. 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 .

7. 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 .

8. Type IV - Extended radical hysterectomy Removal of all periureteral tissue, superior vesicle artery and ¾ of vagina . Differ from the type III procedure—three fourths of the vagina and paravaginal tissue are excised. Type V - Exenteration The terminal ureter or a segment of the bladder or rectum is removed along with the uterus and parametria ( supralevatorial ).

9. Radical Trachelectomy A lso   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.

10. 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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